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I'm shipping on behalf of: *

Myself (personal)
Company (business)

Type of Freight

Ocean Freight
Air Freight
Ground Freight

Name *

First

Middle

Last

Company Name:

Address Line 1 *

Apt or Bldg

Address Line 2

City *

State

Country *

Zip code

Email *

Phone *

Mobile phone

Containers Pick Up Location:

Same as the address above
Different Location

Address of pickup location if different

Apt or Bldg

Address Line 2

City

State

Country

Zip code

Commodity Information and Destination

Domestic - Local
International

Commodity Destination Address *

Apt or Bldg

Address Line 2

City *

State

Country

Zip code

Port Name

Port Name List

Shipment Type

If Others Please Describe

Type of Release

Telex and Express Release
Original Bill of Lading

Additional Services

Cargo Insurance
Custom Clearance
Carrier Services (FedEx, DHL, TNT)

Name

Customer Form

Contact Name *

First

Middle

Last

Company Name:

Address Line 1 *

Apt or Bldg

Address Line 2

City *

State

Country *

Zip code

Email *

Phone *

Passport/Travel Document Nationality/Identity *

Passport /Travel Document Nationality/Identity If not listed above

(Passport Information or Company Tax Exempt ID# required for customs clearance. No social security numbers are accepted. Please DO NOT submit any social security number.)

Passport or Travel Document Number *

(Passport Information or Company Tax Exempt ID# required for customs clearance. No social security numbers are accepted. Please DO NOT submit any social security number.)

EIN Number:

(Passport Information or Company Tax Exempt ID# required for customs clearance. No social security numbers are accepted. Please DO NOT submit any social security number.)

Consignee Name *

First

Middle

Last

Consignee Company Name

Consignee Address

Apt or Bldg

Consignee Address Line 2

City *

State

Country

Zip code

Consignee Email *

Consignee Phone Number *

Consignee Fax Number

Notify Contact Name *

First

Middle

Last

Notify Contact Company Name

Notify Contact Address *

Apt or Bldg

Notify Contact Address Line 2

Notify Contact City

State

Country

Zip code

Notify Contact Email *

Notify Contact Phone Number *

Notify Contact Fax Number

Disclaimer *

I certify that this shipment does not contain any unauthorized explosives, destructive devices or hazardous materials. I consent to a search of this shipment. I am aware that this endorsement and original signature, along with other shipping documents will be retained on file until the shipment is delivered.

Name

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