Sender:          
Name: Company:
Dept / Floor:
   
Address:
City:
State:
Zip:
Phone:
 ( ) - E-mail:
Shipper Ref # :
Recipient:      
Name:
Company:
Dept / Floor:
    
Address:
City:
State:
Zip:
Phone:
 ( ) - E-mail:
Consignee Ref # :
Bill to :
(if other than shipper or consignee)
Declared Value: $
PCS Description of Packing and Contents
Weight
  
 
 
 
Dimensional Wt.      
  PCS L W H
Special Instructions:      
Service Requested:
   
       
Pick-up Ready Date:
   
Time:
Closing Time: