Rate Request Form

REQUESTER

Full Name: *

Company Name:

Address:

City:

Province:

Postal Code:

Telephone: *

( ) -

Fax:

( ) -

E-Mail: *

Best to Respond To:

Phone Fax E-Mail

LOAD DESCRIPTION

Type of Commodity: *

Weight of Commodity: *

Value Of Load: *

Is Product Palletized?

Yes No

If Palletized, Is It Exchange?

Yes No

LOAD ORGIN

City: *

Province/State: *

Delivery Date: *

LOAD DESTINATION

City: *

Province/State: *

Delivery Date: *

ADDITIONAL INFORMATION

Comments or Questions:

Do you have a Website?

Yes No

If yes, what is the URL: