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1. Your Company name and address:
Company Name:*
Address:*
City:*
State:
Zip Code:
Country:*
Contact Full Name:*
Tel:*
Mobile:
Email:*
2. Origin of Cargo:
Same as Your Company
Origin Name:
Address:
City:
State:
Zip Code:
Country:
Contact Full Name:
Tel:
Mobile:
Email:

3. Shipper/Exporter:
Same as Your Company
Shipper Name:
Address:
City:
State:
Zip Code:
Country:
Contact Full Name:*
Tel:
Mobile:
Email:
4. Consignee/Receiver:
Consignee Name:*
Address:*
City:*
State:
Zip Code:
Country:*
Contact Full Name:*
Tel:*
Mobile:
Email:*

5. Cargo Commodity/Description:*
6. Hazardous Material:*
7. Cargo:
Pieces:*
Dimensions (L x W x H in inches):*
Weight Per Piece (Lbs):*
8. Customs Value ($):*
10. Cargo Ready Date:*
9. Additional Insurance Required:*
11. Delivery Date Required:*

12. Comments/Special Instructions
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