TODAY’S DATE:  

DATE OF PICK UP:     

TODAY’S TIME:  

DATE OF DELIVERY:     

CUSTOMER / BILL TO:

P/U DOCUMENTS AT:

NAME       

NAME       

ADDRESS

ADDRESS

ATTN:       

TEL: 

TEL: 

REF #:       

DELIVER FREIGHT TO:

P/U FREIGHT AT:

NAME       

NAME       

ADDRESS

ADDRESS

ATTN:       

ATTN:       

TEL: 

TEL: 

No. OF PIECES:
     

GROSS WEIGHT:
     

MEASUREMENTS:
     

VOLUME WEIGHT:
     

DESCRIPTION:


     

REMARKS:

VALUE DECLARED FOR VALUATION INSURANCE CHARGE (OPTIONAL)

$