Rates Request

Please fill out the information below and an A&B Courier Traffic Specialist
will contact you very shortly with your quotation. Fields marked with an ^* are mandatory. Thank-you.

CONTACT INFORMATION
Name:^*
Telephone:^*	^{Please enter in (xxx) xxx-xxxx format}
Email:^*

ORIGIN		DESTINATION
Address		Address
City^*		City^*
Province / State^*		Province / State^*
Postal / Zip Code^*		Postal / Zip Code^*
Country^*		Country^*
Loading Dock?^*	Yes - No	Loading Dock?^*	Yes - No

FREIGHT DESCRIPTION
Pieces^*	^*	Dimensions First Skid
Total Weight^*	Lbs.	Length^* X Width^* X Height^*
Shipment Value^*	[$ CDN]	Dimensions for additional skids if different size
Hazardous^*	Yes - No	Length X Width X Height
Hazardous Description		Length X Width X Height
		Length X Width X Height
Commoditiy Description		Length X Width X Height
HS Code		Length X Width X Height

EQUIPMENT NEEDED
Tractor
Straight Truck
	Special Equipment Required: Description
Name of Custom Broker

PICKUP INSTRUCTIONS		DELIVERY INSTRUCTIONS
Residential		Residential
Tailgate		Tailgate
Construction Site		Construction Site
Pickup Date		Deliver By
Pickup Time	:	Delivery Time	:
Other		Other

ADDITIONAL CONTACT INFORMATION
Name		Telephone
Company		Fax
Address		Email
City		A&B Courier Account #:
Province/State		Comments
Postal/Zip Code
Country

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