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Shipper Information Form

Please fill out the form below. For questions about this form call 913-888-1685.

* Required fields

1. Company Information
* Company Name:
* Billing Address:
Parent Company:
2. Contact Information
* First Name:
* Last Name:
* Title:
* Phone:
Fax:
* E-mail:
3. Business Information
* Industry:
* Type of Business:
Corporation Partnership
LLC Proprietorship

* In Business since:
* Tax I.D. #

* Outbound Shipping Locations:

1.

2.

3.

4.

5.


* Shipping Frequency:
Daily Weekly Monthly Other

* Truckload Shipment %
* Less than Truckload Shipment %
* Cargo Value Per Load U$

* Type of Freight:
* Type of Vehicle:

* Dimensions: Width Height Depth
* Net Weight:

* Cargo Description:

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