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CONTACT INFORMATION
Account Code:
*Contact Name:
*Company Name:
*Telephone:
Fax:
E-mail:
Contact By:
Phone
Fax
E-Mail
SHIPMENT DETAILS
ORIGIN
*Name:
*City:
Postal Code/ZIP:
Province/State:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Type of Pick-up:
Business With Loading Dock
Business Without Loading Dock
Residential Pickup
Inside Pickup
DESTINATION
*Name:
*City:
Postal Code/ZIP:
Province/State:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Type of Drop:
Business With Loading Dock
Business Without Loading Dock
Residential Pickup
Inside Pickup
Pieces
Package Code
Description
Total Weight
Units
Length
Width
Height
Units
APP - Appliance
BOX - Box/Carton/Container
CAS - Casket
CYL - Cylinder
DRM - Drum
ENV - Envelope
FLM - Film
KEG - Keg
MAT - Mattress
MB - Mailbag
PLT - Pallet/Lift/Crate
TIR - Tire
TRA - Transmission
lbs
kgs
in
ft
m
cm
**Please ensure you are entering the total weight for the shipment, not a per piece weight. All shipments are subject to cubing.
OTHER SERVICES
Insure Goods:
(only if new crated product)
**Declared Value $
**Maximum liability of $2.00 per pound unless declared valuation states otherwise.
Dangerous Goods
Protective Service/Heat
Flat Deck Pickup
Flat Deck Delivery
Tarping
PAYMENT TERMS
Prepaid (Shipper)
Collect (Consignee)
Third Party
COMMENTS / SPECIAL INSTRUCTIONS
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The Hi-way 9 Group of Companies are subsidiaries of Mullen Group Ltd.