Rate request

1.	Name * 2. Last Name *
3.	Company Name
4.	Address
5.	Email *
6.	Telephone * 7. Fax
8.	ZIP / Postal Code for pick up or name of port *
9.	ZIP / Postal Code for delivery or name of port *
10.	Weight of shipment *
11.	Dimensions * : length , width , height
12.	Value of cargo USD
13.	Do You need insurance Yes or No
14.	Date of shipment *
15.	Service * \ 16. Additional services
17.	Residential pick up * Yes or No 18. Residential delivery * Yes or No
19.	Shipping mode * Air Ocean truck Intermodal
20.	Dangerous goods * Yes or No
21.	Commodity description *
22.	Commodity class
23.	Is a lift gate truck required residental pick up delivery
24.	Comments