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State/Province*

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TL (Truckload) or LTL (Less than Truckload)?*

Stackable ?*

# of Loose Items

# of Loose Boxes

# of Pallets

# of Crates

All dimensions are in:

Dimensions & Quantities of Loose Items & Boxes, Pallets and Crates

Qty	Length	Width	Height

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Equipment Required*

Total Weight:*

Lbs./ Kilos*

Class:

Tot. Value:*

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Equipment Required*

On Pallets ?*

Total Weight:*

Lbs./ Kilos*

Any Hazardous Material ?*

If Hazmat, Please Enter Class/U.N. #:

Shipment Pickup Date:*

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General Description of Goods/Special Instructions:*

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