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  Pick Up Request
   
Contact Information
   
Name:
Company Name:
Phone:
E-Mail Address:
   
Pickup Location
   
Contact Name:
Company Name:
Street Address:
City, State/Prov., Zip/Postal Code: , ,
Phone Number:

P.O. #:

   
Delivery Location
   
Contact Name:
Company Name:
Street Address:
City, State/Prov., Zip/Postal Code: , ,
Phone Number:
   
Shipment Information
   
Requested Pickup Date:
Number of Shipments:
Total Pieces for All Shipments: No.
Total Weight:

Note: The time for the pickup needs to be the time zone of the pickup location.

   
My Shipment Will Be
Available For Pickup By:
   
Dock Closes At:
   
Hazardous Materials? Yes No
   
If Haz Mat, Please Provide ID NBR:
   
Liftgate? Yes No
   
Payment Terms:
   

   

 

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