Company (shipper's) name*
Contact person*
Address Country
State/Province
City
Zip/Postal Code
Contact information
Phone*
Fax
E-mail*
Place of Origin Country*
City or Airport*
Place of Delivery Country*
Commodity*
Dimensions*
Total Volume in cubic metres cubic feet
Gross Weight in kg
Packing details boxes cartons cases pallets barrels bags other
If "other" please specify
IMO Class/Hazardous Goods No Yes
UN Number* Class*
Cargo ready for shipment on
MM: 01 02 03 04 05 06 07 08 09 10 11 12 DD: 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YY:
Freight Prepaid Collect
Cargo Insurance Required* No Yes
Invoice Value
Expected frequency of shipments
up to 6 up to 12 up to 24 up to 36 over 36 N/A per month quarter year
Preferred carrier
Special requirements/remarks
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