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Customer Information
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First Name*
Last Name*
Company Name
Job Position
Street
City
Province/State
Country
Postal / Zip Code
Tel No.*
Fax No.
Cell No.
Email*
Shipment Information
Origin of Cargo
Destination of Cargo
Estimated Total Volume
Estimated Total Weight
Mode of Transport
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Air
Ocean
Truck/Train
Service Required
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Dock to Dock
Dock to Door
Door to Dock
Door to Door
Shipment Category
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Commercial
Heavy Equipment
Personal Effects
Vehicles
Total Number of Pieces
Weight Per Item in
kg
lb
Dimension Per Piece (LXWXH) in
ft
meter
Vehicle (if applicable)
(Specify make, model and year)
Heavy Equipment (if applicable)
(Specify LXWXH and Weight)
Declared Value
CAD
USD
Insurance
Required
Not Required
Pickup and Delivery Info
Pickup Date
Day
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Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Delivery Date
Day
1
2
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Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Pickup Address
Stairs Required to Reach Destination
Delivery Address
Stairs Required to Reach Destination
Comments
Special Instructions
