Customer Name
SHIP TO ADDRESS:
Company Name
Address
City
Country
Phone #
Province/Region
Postal Code
Fax #
Reveiver's Name
Receiver's Ext
Email Address
Receiver's Hours
Receive After Hours? If you are able to receive after hours, please list the after hour times
Appointment Required?
YesNo
Dock Level?
53 Inch Trailer Accessible?
Pump Truck Required?
Phone Call Required?
Ground Level?
Hand Bomb Required?
Please check all that applies:
No overhangNo double stackingUnitizePalletizePallet wrap2 units on 1 pallet
Maximum Load Height (including skid in inches)
Additional Information and/or Special Instructions:
