Shipper EIN / Tax ID #

    Shipper / Exporter                      

    Reference Number

    Address

    City

    State            Zip

    Phone

    Fax

    Contact Name

    E-mail

    Schedule B Number (if known)

    Commodity Description

 

    Origin

    Destination

    Routing

    Date of Shipment

    Insurance Coverage       $     Valuation of Shipment

    Shipping Terms        Chart of Terms

    Shipping Method

    Hazardous Cargo            Hazmat Method

        UN Number

 

Enter the dimensions (in inches) and actual weight of each piece on the form below.    Measurement Converter