P.O.D. Request Form

YOUR NAME:
YOUR E-MAIL:
COMPANY NAME:
COMPANY ADDRESS:
PHONE #: (999) 999-9999
FAX #: (999) 999-9999
PICKED UP FROM:
DATE REQUESTED:
CONFIRMATION #
PICK UP DATE
DELIVERY DATE
SHIPPER
CONSIGNEE
# PIECES WEIGHT
BILL OF LADING # P.O.D.
How would you like to receive the P.O.D.?     E-MAIL FAX
   
  

Or Print and Fax to: (519) 284-0165