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I am the (select all that apply): ShipperConsigneeOther
Payment Terms* PrepaidCollect
Requester Information
Contact*
E-mail
Phone*
Ext
Shipper
Company Name*
Additional Information
Street Address*
Country United StatesCanadaOther
City*
State* (Select State)ALABAMAALASKAARIZONAARKANSASCALIFORNIACOLORADOCONNECTICUTDELAWAREDISTRICT OF COLUMBIAFLORIDAGEORGIAGUAMHAWAIIIDAHOILLINOISINDIANAIOWAKANSASKENTUCKYLOUISIANAMAINEMARYLANDMASSACHUSETTSMICHIGANMINNESOTAMISSISSIPPIMISSOURIMONTANANEBRASKANEVADANEW HAMPSHIRENEW JERSEYNEW MEXICONEW YORKNORTH CAROLINANORTH DAKOTAOHIOOKLAHOMAOREGONPENNSYLVANIAPUERTO RICORHODE ISLANDSOUTH CAROLINASOUTH DAKOTATENNESSEETEXASUTAHVERMONTVIRGIN ISLANDSVIRGINIAWASHINGTONWEST VIRGINIAWISCONSINWYOMING
Zip*
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Reference No. for Pick Up
Pick Up Date
Shipment Ready CALL010203040506070809101112
00153045
AMPM
(select 'CALL' for appointment)
Dock Closes --6:00 AM6:30 AM7:00 AM7:30 AM8:00 AM8:30 AM9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AMNoon12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM8:30 PM9:00 PM9:30 PM10:00 PM10:30 PM11:00 PM11:30 PMMidnight12:30 PM1:00 AM1:30 AM2:00 AM2:30 AM3:00 AM3:30 AM4:00 AM4:30 AM5:00 AM5:30 AM
CONSIGNEE INFORMATION
THIRD PARTY PAYER INFORMATION
Company Name
Street Address
City
State (Select State)ALABAMAALASKAARIZONAARKANSASCALIFORNIACOLORADOCONNECTICUTDELAWAREDISTRICT OF COLUMBIAFLORIDAGEORGIAGUAMHAWAIIIDAHOILLINOISINDIANAIOWAKANSASKENTUCKYLOUISIANAMAINEMARYLANDMASSACHUSETTSMICHIGANMINNESOTAMISSISSIPPIMISSOURIMONTANANEBRASKANEVADANEW HAMPSHIRENEW JERSEYNEW MEXICONEW YORKNORTH CAROLINANORTH DAKOTAOHIOOKLAHOMAOREGONPENNSYLVANIAPUERTO RICORHODE ISLANDSOUTH CAROLINASOUTH DAKOTATENNESSEETEXASUTAHVERMONTVIRGIN ISLANDSVIRGINIAWASHINGTONWEST VIRGINIAWISCONSINWYOMING
Zip
Contact
Phone
Shipment Details
Handling Units
# of
type --BagBaleBarrelBasketBoxBucketBulkheadBundleCarboyCartonCaseChestCoilCrateCylinderDrumFirkinHamperHogsheadKegPackagePailPalletPieceRackReelRollSkidSlip SheetToteTrailerTrunkTube
Packages
Weight(lbs)
Class --BagBaleBarrelBasketBoxBucketBulkheadBundleCarboyCartonCaseChestCoilCrateCylinderDrumFirkinHamperHogsheadKegPackagePailPalletPieceRackReelRollSkidSlip SheetToteTrailerTrunkTube
NMFC(Item)
Sub
Cube(cuft)
Haz Yes
e.g.3 pallets of 40 total cartons)
Description
Declared Value
Added charges will apply for this charge. This covers against damage or loss as per our Terms & Conditions
Transit Time Required
LTLSecured Overnight GuaranteedNext Day by MorningNext Day During Business Hours2nd DayThree Day ServiceDeferred 2-5 Business DaysFull TruckloadInternational
ADDITIONAL SERVICES
Pickup Options Liftgate-At PickupInside PickupLimited Access PickupResidential PickupTrade Show Pickup
Delivery Options Construction Site DeliveryCall Before DeliveryFlatbed DeliveryLiftgate-At DeliveryInside DeliveryLimited Access DeliveryResidential DeliveryCOD (collect for goods)Trade Show Delivery
SEND CONFIRMATION COPY
Send copy of this Pickup Request to
Send confirmation notice when shipment is picked up to
E-mail the Shipper
Yes
E-mail the Consignee
E-mail the Third Party
Also send to this e-mail address
ADDITIONAL INSTRUCTIONS
BEFORE SUBMITTING FORM, PLEASE BE CERTAIN CONTACT INFORMATION IS FILLED IN (SHIPPER, CONSIGNEE, OR OTHER).
I have read and agree to the Alliance Air Freight's Terms & Conditions of Contract. Please see link at top of page.
Yes I agree with the Terms & Conditions.No I do not agree with the Terms & Conditions.
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