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Date

 

TRUCK RATE REQUEST
Contact *
Company Name *
Address
City / ST / ZIP
Phone *
Fax *
Email *
Comments
SHIPMENT INFORMATION
Commodity *
Weight
Hazardous? *
Yes
No
 
If Yes, UN #   
Class Packing Group /
Volume
Monthly
Weekly
  NOTE: Origin & Destination States now include Canada & Mexico
Origin*
City *
State*
 
 
Destination*
City *
State*
Equipment Type *
Container
Standard
HC
Open Top
Flatrack
 
or
      
 
Trailer
     
Ownership
Steamship Line
Rail
Private
Size *
53'
48'
45'
40'
20'
check all that apply
How Currently Moving
Truck Rail  
Rate Needed
Flat
$
cpm
 $
Are you currently working with a Cornerstone Systems Sales Representative?* Yes No Cornerstone Rep
If yes, please list here

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