About You

Name:

*

Company Name

Phone

*Ext.

(Note: Please enter phone and fax numbers in the format XXX-XXX-XXXX or XXX XXX XXXX.)

E-mail

*

Yes No

Do you need airbills?

About the Pickup Origin

Contact Name

Company Name

Street Address

City, State, Zip

Phone

*Ext.

Is there a dock at this location? Yes No

About the Shipment

Requested Pickup Date

Type of Freight

General freight    Show freight   Other

Service Level/Priority

Next Day   2nd day   3-5 day   LTL   Truckload   Slow boat to China

Available for Pickup By

1:00 1:30 2:00 2:30 3:00 3:30 4:00 4:30 5:00 5:30 6:00 6:30 7:00 7:30 8:00 8:30 9:00 9:30 10:00 10:30 11:00 11:30 AM PM

Dock Closes At

Liftgate Needed

Yes No

Pickup Notes

About the Destination

City, State, Zip

Is there a dock at this location? Yes No

Is this a round trip move? Yes No

(* A Champion representative will contact you for complete delivery instructions.)

Optional Billing Information

Company Name

Street Address

City, State, Zip