RATE REQUEST FORM
P.O.Box NO. 1019 
Westmont, Illinois 60559 
Tol Free : 800-495-6047 
Fax & Voice Message : 800-495-6093 
 REQUESTOR INFORMATION :   Shipper Acct  #
:
  
 Required to process a pickup request   Consignee Ref  # :  
 (Please print or type all information)   Third Party Date :  
 Requestor Name : 
  Cust. Ref # :  
  Cust. P.O. # :   
  Date of Shipment :  
  Pickup Time :   
  (This will be the P.O # which will appear in the delivery reciept)
 Company Name : 
 Address1 : 
 Address2 : 
 City / State :
 Zip / Country :
   
 
 Phone :  Fax : 
  Email 
  : 
 SHIPPER INFORMATION :  Same as above   CONSIGNEE INFORMATION :   Same as above 
 Company Name :    Company Name :  
 Contact :    Contact :  
 Address1 :    Address1 :  
 Address2 :    Address2 :  
 City / St / Zip :     City / St / Zip :  
 Phone :   Fax :    Phone :   Fax :  
No. of Pieces
No. of Skids
H/M
Description
Class
Weight (lbs) 
 
 
 
 
 
   
 
 
 
 
 
   
           
           
           
 SERVICES  
 Shipment stackable Yes No
 1. [  ] Letter or Package [Domestic]    DELIVERY TIME
Date
Date &Time
 Guaranteed
  a. Letter [  ] b. Package [  ]  Same day
[  ]
[  ]
[  ]
 2 .[  ] Local [Metro]    Next business day
[  ]
[  ]
[  ]
  a. Messenger service [  ] d. Straight truck [  ]  Second business day
[  ]
[  ]
[  ]
  b. Mini van [  ] e. Tractor-trailor [  ]  Third business day
[  ]
[  ]
[  ]
  c. Cargo van [  ]      Other
[  ]
[  ]
[  ]
 3. [  ] Expedited [Domestic ground]  
  a. Cargo van [  ] c. Tractor-trailer [  ]  
  b. Straight truck [  ]    ACCESSORIAL SERVICES
 4. [  ] LTL [Less than truck load]    1.   Residential pickup
[  ]
 13. Strap & Tarp [  ]
  a. Metro [  ] c. Out of state [  ]  2.   Residential delivery
[  ]
 14. Detention time [  ]
  b. Instate [  ]    3.   Inside pickup
[  ]
 15. Stop offs [  ]
 5. [  ] Truck load/ Volume load    4.   Inside delivery
[  ]
 16. Cross dock [  ]
  a. Pup (28Ft.) [  ] c. 3/4 Truck load [  ]  5.   Construction site pickup
[  ]
 17. Storage [  ]
  b. 1/2 Truck load [  ] d. Full truck load [  ]  6.   Construction site delivery
[  ]
 18. Exhibition services [  ]
 6. [  ] Rail/ Intermodal    7.   Lift gate
[  ]
 19. Border crossing [  ]
 7. [  ] Air [Domestic]    8.   Arrival notification
[  ]
 20. Refrigeration services [  ]
  a. Next flight out [  ] c. Dock to dock [  ]  9.   Blind shipment
[  ]
 21. Air-ride equipment [  ]
  b. Air charter [  ]    10. Hazardous material
[  ]
 22._____________________ [  ]
 8. [  ] International    11. Tagging & Marking
[  ]
 23._____________________ [  ]
  a. Letter (air) [  ] c. Ocean (LCL) [  ]  12. Sorting & Segregating
[  ]
 24._____________________ [  ]
  b. Package (air) [  ] d. Ocean (FCL) [  ]        
 Del. special instructions :
 Special comments :
 Requestor's Signature : Name : Date :
This form can be input online or can be downloaded from our website at : www.econoship.com Form:1003
Rev# 1   Dt:10/13/03