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Your Name
Company Name
Email Address
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Contact Name
Company
Phone
Address
Address 2
City, State, Zip    
What time will your shipment be ready
for pick up? (local time)
 
Contact Name
Company
Phone
Address
Address 2
City, State, Zip    
 
Ship Date     mm/dd/yyyy
How many pieces are there in this shipment?
What is the total weight of this shipment? lbs
How heavy is the heaviest piece? lbs
What are the individual dimensions of the
pieces in your shipment? (in inches)
# of Pieces Length Width Height
 
Type of Packaging
 
Description of Contents/Commodity
 
Is insurance required? Yes    No
If you need insurance, how much will be required?   
 
Hazardous Yes    No
 
Payment Method Prepaid     Collect     Third Party
 
Level of Service Required Next Day - AM (Next Business Day)
Next Day - PM
2nd Day - AM
2nd Day - PM
3rd Day

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6404 S. Rockford Dr. - Tempe, AZ 85283   USA

(800) 466-6980    Corporate Office
(480) 350-9927    Tempe, AZ - PHX
(310) 322-2515    Los Angeles - LAX
(630) 709-5198    Chicago - ORD