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WA0117 
 

PCI Pickup Request

   
Shipment Type:  Road Freight   Air Freight   Ocean Freight 
Shipper's Information
Date: Shipper's Ref.#:
Shipper:
Street Address:
City: State: Zip:
Contact Name: Telephone#:
Email:
Terms and Conditions of Service
Consignee's Information
Consignee's Ref.#:
Consignee:
Street Address:
City: State: Zip:
Contact Name: Telephone#:
Email:
                       
Service Description: Service: Terms:
Form of Payment
 Bill Shipper
 Bill Consignee
  Third Party Bill to Company




 

Special Instructions
Liablity for the Forwarder is limited to $.50 per pound of that part of the consignment lost, damaged, or delayed. The Forwarder will maintain a cargo liability insurance policy with an insurance company to cover such liability. Indicate amount to be insured in box marked "Amount of insurance".
Amount of Insurance:
Total Pieces
Description of Packing and Contents
Total Weight
 
Requested Pickup Time Date:    Time: