eShipping Pick Up Form

* - Required Fields

*Name of Billing Client:   *Your Name:        *Your Phone Number:

SHIP FROM *Company Name   *Address   *City        *State   AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY DC      *Zip Code   *Contact Name          Contact Email   *Phone Number         Fax Number

SHIP TO *Company Name   *Address   *City        *State   AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY DC      *Zip Code    Contact Name          Contact Email    Phone Number          Fax Number

SHIP DETAIL *Shipment Date        *Ready Time        *Close Time   *Service Required   LTL      TL Dry Van      TL Flatbed      Air by Noon      Air By 5PM      Expedited/Hotshot ITEM #1 *Description    Class   505560657077.58592.5100110125150175200250300400500 *Pieces/Pallets     *Total Weight  lbs. NMFC   *Dimensions (length)     X (width):    X (height):   *Hazmat? Yes    *Stackable? Yes      Standard Size? Yes   No   No   No ITEM #2  Description    Class   505560657077.58592.5100110125150175200250300400500  Pieces/Pallets      Total Weight  lbs. NMFC    Dimensions (length)     X (width):    X (height):    Hazmat? Yes     Stackable? Yes      Standard Size? Yes   No   No   No

*PO#     *Date Must Deliver By   (Enter N/A if no date provided)       Pick Up#   Special Instructions

*Do you need insurance?   Yes    No       Value of goods (for insurance purposes - not disclosed on BOL)

Notes

International Customs Broker Name (if applicable)   Phone Number        Fax Number

I AGREE to allow 20 minutes for a Bill of Lading and a two (2) hour window for all LTL shipment pickups. Please Note: For Volume and FTL shipments, a Bill of Lading will be issued as soon as a truck is assigned. Exceptions can be submitted to pickups@eshipping.biz