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Freight Company Details
Company Information

* Company Name F.C.ID NO.(For office use only)
   Contact ICC Licence No
* Address Tariff/Rate #
   Address 2 Effective Date
* City    
* State   States in (Canada & Mexico):    
* ZipCode    
* Country    
* Phone - -    
    Fax - -    
   Email    

Payment Mailing Address
Same as company information

* Company Name
   Contact
* Address
   Address 2
* State States in (Canada & Mexico):
* City
* ZipCode
* Country
* Phone - -
    Fax - -
    Email

Direct Service Areas :Nationwide Yes  No (if no, check the appropriate states below)
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
    

MEXICO CANADA Note: please mail the service area map, service guide book & rate disk minimum 2 sets).

 SERVICES    ACCESSORIAL SERVICES
 1. Letter or Package [Domestic]  1.   Residential pickup 14. Detention time
  a. Letter b. Package  2.   Residential delivery 15. Stop offs
 2. Local [Metro]  3.   Inside pickup 16. Cross dock
  a. Messenger service d. Straight truck  4.   Inside delivery 17. Storage
  b. Mini van e. Tractor-trailor  5.   Construction site pickup 18. Exhibition services
  c. Cargo van    6.   Construction site delivery 19. Border crossing
 3. Expedited [Domestic ground]  7.   Lift gate 20. Refrigeration services
  a. Cargo van c. Tractor-trailer  8.   Arrival notification 21. Air-ride equipment
  b. Straight truck    9.   Blind shipment 22. Container hauling service
 4. LTL [Less than truck load]  10. Hazardous material 23. Flatbed
  a. Metro c. Out of state  11. Tagging & Marking 24. Tanker
  b. Instate    12. Sorting & Segregating 25. Team
 5. Truck load/ Volume load  13. Strap & Tarp
   
  a. Pup (28Ft.) c. 3/4 Truck load  (List other services, attach additional page if required)
  b. 1/2 Truck load d. Full truck load        
 6. Rail/ Intermodal Indicate the number of equipment in your fleet
 7. Air [Domestic]   Cargo van
  a. Next flight out c. Dock to dock Straight truck
  b. Air charter   Tractor-trailor
 8. International Other
  a. Letter (air) c. Ocean (LCL)  (Attach list of all regional office terminals, include address, phne, fax,   contact info.)
  b. Package (air) d. Ocean (FCL)
      

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