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Company Name:
Contact:
Phone #:
Fax #:
New
Used
One-Time Shipper
Continuous Shipper
Value:
FOB
CIF
C & F
Origin:
Via the Port of:
Destination:
By:
Truck
Rail
Air
Ocean
To Arrival Port of:
By:
Truck
Rail
Air
Ocean
To Final Destination of:
Carrier:
Date of Departure:
Commodity:
Packaging:
# of Packages:
Check all that apply or describe:
FCL
LCL
Refer
Open Top
Bags(Plastic/Paper)
Flat Rack
Breakbulk
RoRo
Cartons
Drums(Steel/Fiber)
Crates
Cradle
Palletized
Banded(Plastic/Metal)
Master Cartons
Tarped
Shrink Wrapped
Pails(Plastic/Fiber)
Packed Professionally
Is shipment on a door to door bill issued by carrier?
Yes
No
Are you issuing a door to door house bill?
Yes
No
Insurance terms needed?
All Risk
With Average
FPA
Insurance coverage needed?
Door to Door
Port to Port
Door to Port
Port to Door
Other:
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