International Express, Inc.
Loose Cargo Pick-Up & Delivery Request

 

1. Date of Request (mm/dd/yyyy):    2. Date of Pick-Up/Delivery (mm/dd/yyyy):   

 

3. Consignee: 

 

4. Address: 

 

5. Billing Address

 

6. Contact Information:

     a. Name:    b. Phone #:      c. Email:

 

8. Area - From:        9. Area - To:

 

10. Pick-Up Time:   11. Delivery Time:

 

12. Description:

 

13. Inside Delivery?:      14. Assistant Needed?:      15. Wagon?:

 

16.  Pallet Count:       17.  Piece Count:       18.  Total Weight:

 

19.  Hazardous Material:       20. Measurement(cm3):       21.  BL/NO.: 

 

22. Credit: (Approved by David)

 

23.  Remarks:

 

                      

       

Make sure to save a copy for your records.
We will reply to you as soon as we accept your request to confirm.
If you have any questions, please send an e-mail to Joel Domingo at: joel@interexp.com