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Multiple Pickup Request
As the shipper you may submit multiple shipments for pickup. You can enter up to 5 different destination shipments for your convenience.
All yellow fields are required.
Pickup Location
Shipper Contact Name:
CT Loc #:
Company Name:
Address:
City:
State/Country/Zip:
- - -
AK
AL
AR
AZ
CA
CO
CT
DC
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
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
CAN
MEX
USA
Phone:(
)
-
Ext
Same as Shipper Info
Requester Contact Name:
Company Name:
Phone:(
)
-
Ext
Please enter your email addess if you would like to receive confirmation of this request.
Email:
Pickup Specifics
Pickup Date:
Select Date
4/12/2021
4/13/2021
4/14/2021
4/15/2021
4/16/2021
4/19/2021
4/20/2021
4/21/2021
4/22/2021
4/23/2021
4/26/2021
4/27/2021
4/28/2021
Ready Time:
1:00 AM
2:00 AM
3:00 AM
4:00 AM
5:00 AM
6:00 AM
7:00 AM
8:00 AM
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
5:00 PM
6:00 PM
7:00 PM
8:00 PM
9:00 PM
10:00 PM
11:00 PM
Midnight
Dock Close Time:
1:00 AM
2:00 AM
3:00 AM
4:00 AM
5:00 AM
6:00 AM
7:00 AM
8:00 AM
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
5:00 PM
6:00 PM
7:00 PM
8:00 PM
9:00 PM
10:00 PM
11:00 PM
Midnight
*Shipper's Local Time
Pallets larger than 48x48
Capacity Load
Stackable Pallets
No Dock
Non-Stackable Pallets
Residential Pickup
Appointment
Should CT contact shipper to arrange pickup?
Yes
No
Linear Feet Needed:
Special Instructions:
Destination Information (1)
Consignee Information
Company Name:
Address:
City:
State/Country:
- - -
AK
AL
AR
AZ
CA
CO
CT
DC
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
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
CAN
MEX
USA
Zip Code:
Phone:
(
)
-
Ext
Pro Number:
Payment Terms
:
Prepaid
Collect
Third Party
Hazardous Materials
:
Yes
No
Commodities
Handling Units
# of Units:
Type:
Class:
Weight:
- - - - - - - - - - -
BOX
BAG
BUCKET
ENGINE
CRATE
CARTON
CYLINDER
DRUM
LOOSE
PAIL
PALLET
RACK
SKID
TOTE
TANK
OTHER
- - - - - - - - - - -
50CL
55CL
60CL
65CL
70CL
77.5CL
85CL
92.5CL
100CL
110CL
TRUCKLOAD RATE
125CL
150CL
175CL
200CL
250CL
300CL
400CL
Arrival Notification
Excess Liability Charge
COD
Sort & Seg
Inside Delivery
Residental Delivery
Appointment
Lift Gate
Reference Numbers
BOL #
P.O. #
Customer Ref. #
Destination Information (2)
Consignee Information
Company Name:
Address:
City:
State/Country:
- - -
AK
AL
AR
AZ
CA
CO
CT
DC
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
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
CAN
MEX
USA
Zip Code:
Phone:
(
)
-
Ext
Pro Number:
Payment Terms
:
Prepaid
Collect
Third Party
Hazardous Materials
:
Yes
No
Commodities
Handling Units
# of Units:
Type:
Class:
Weight:
- - - - - - - - - - -
BOX
BAG
BUCKET
ENGINE
CRATE
CARTON
CYLINDER
DRUM
LOOSE
PAIL
PALLET
RACK
SKID
TOTE
TANK
OTHER
- - - - - - - - - - -
50CL
55CL
60CL
65CL
70CL
77.5CL
85CL
92.5CL
100CL
110CL
TRUCKLOAD RATE
125CL
150CL
175CL
200CL
250CL
300CL
400CL
Arrival Notification
Excess Liability Charge
COD
Sort & Seg
Inside Delivery
Residental Delivery
Appointment
Lift Gate
Reference Numbers
BOL #
P.O. #
Customer Ref. #
Destination Information (3)
Consignee Information
Company Name:
Address:
City:
State/Country:
- - -
AK
AL
AR
AZ
CA
CO
CT
DC
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
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
CAN
MEX
USA
Zip Code:
Phone:
(
)
-
Ext
Pro Number:
Payment Terms
:
Prepaid
Collect
Third Party
Hazardous Materials
:
Yes
No
Commodities
Handling Units
# of Units:
Type:
Class:
Weight:
- - - - - - - - - - -
BOX
BAG
BUCKET
ENGINE
CRATE
CARTON
CYLINDER
DRUM
LOOSE
PAIL
PALLET
RACK
SKID
TOTE
TANK
OTHER
- - - - - - - - - - -
50CL
55CL
60CL
65CL
70CL
77.5CL
85CL
92.5CL
100CL
110CL
TRUCKLOAD RATE
125CL
150CL
175CL
200CL
250CL
300CL
400CL
Arrival Notification
Excess Liability Charge
COD
Sort & Seg
Inside Delivery
Residental Delivery
Appointment
Lift Gate
Reference Numbers
BOL #
P.O. #
Customer Ref. #
Destination Information (4)
Consignee Information
Company Name:
Address:
City:
State/Country:
- - -
AK
AL
AR
AZ
CA
CO
CT
DC
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
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
CAN
MEX
USA
Zip Code:
Phone:
(
)
-
Ext
Pro Number:
Payment Terms
:
Prepaid
Collect
Third Party
Hazardous Materials
:
Yes
No
Commodities
Handling Units
# of Units:
Type:
Class:
Weight:
- - - - - - - - - - -
BOX
BAG
BUCKET
ENGINE
CRATE
CARTON
CYLINDER
DRUM
LOOSE
PAIL
PALLET
RACK
SKID
TOTE
TANK
OTHER
- - - - - - - - - - -
50CL
55CL
60CL
65CL
70CL
77.5CL
85CL
92.5CL
100CL
110CL
TRUCKLOAD RATE
125CL
150CL
175CL
200CL
250CL
300CL
400CL
Arrival Notification
Excess Liability Charge
COD
Sort & Seg
Inside Delivery
Residental Delivery
Appointment
Lift Gate
Reference Numbers
BOL #
P.O. #
Customer Ref. #
Destination Information (5)
Consignee Information
Company Name:
Address:
City:
State/Country:
- - -
AK
AL
AR
AZ
CA
CO
CT
DC
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
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
CAN
MEX
USA
Zip Code:
Phone:
(
)
-
Ext
Pro Number:
Payment Terms
:
Prepaid
Collect
Third Party
Hazardous Materials
:
Yes
No
Commodities
Handling Units
# of Units:
Type:
Class:
Weight:
- - - - - - - - - - -
BOX
BAG
BUCKET
ENGINE
CRATE
CARTON
CYLINDER
DRUM
LOOSE
PAIL
PALLET
RACK
SKID
TOTE
TANK
OTHER
- - - - - - - - - - -
50CL
55CL
60CL
65CL
70CL
77.5CL
85CL
92.5CL
100CL
110CL
TRUCKLOAD RATE
125CL
150CL
175CL
200CL
250CL
300CL
400CL
Arrival Notification
Excess Liability Charge
COD
Sort & Seg
Inside Delivery
Residental Delivery
Appointment
Lift Gate
Reference Numbers
BOL #
P.O. #
Customer Ref. #
Check the Consignee dropdown list below to ensure all destinations that were entered appear in the list.
All entries in list will be submitted for pickup
. You may edit or delete an entry by simply selecting the name from the list and clicking "
Edit
" or "
Delete
" button. (Consignees are numbered in the order entered)
Consignee Name
Zip Code
Handling Units
Weight
Copy Recipients
-
Send copy of Pickup Request to:
Name:
Email:
Name:
Email:
Name:
Email:
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4/12/2021 - 5:10 PM
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4/12/2021 - 5:10 PM
4/12/2021 - 5:10 PM
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