*
Name:
*
E-mail:
*
Company:
Job Title:
*
Address:
*
City:
*
State or Province:
*
Postal Code:
Country:
Fax Number:
*
Phone Number:
Method of Shipping:
AIR
OCEAN
NO. of PCS/PKGS/CTNS
Dimensions:
Weight: (lbs/kilos)
Commodity:
Hazardous:
Yes
No
If you have selected
YES
to the previous "hazardous" item please fill out the items listed below in the red box.
Class #:
UN#:
IMDG or DGD prepared by shipper:
Yes
No
License Required:
Yes
No
Freight Location:
Destination:
Value (US$):
Insurance:
Yes
No
INCO Terms:
FOB Factory
FOB Port/Airport
CFR
CIF
Other
Terms of Payment:
Open Acct
L/C
Bankdraft
Other
Any Comments
or Questions?
* Required Information
