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Employment |
Contact |
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CALL: 800-489-2088
CALL: 800-489-2088
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Panama Transfer Pickup Request
Required Fields *
Pick Up Request
Pick Up Date
Quote Number:
Payment Method * ~ Required
Please select one
Prepaid
Collect
3rd Party
Shipper Information
Shipper Phone:
Shipper:
Address:
Zip Code:
City:
State:
Consignee Information
Consignee:
Phone Number:
Address
City:
State:
Zip Code:
Freight Information
Number of Shipping Units Skid or Piece Count:
Weight:
Freight Description
Hazardous Materials: *
Yes
No
Time Ready:
Choose a time
Noon
1 p.m.
2 p.m.
3 p.m.
4 p.m.
5 p.m.
6 p.m.
7 p.m.
8 p.m.
9 p.m.
10 p.m
11 p.m
Midnight
1 a.m.
2 a.m.
3 a.m.
4 a.m.
5 a.m.
6 a.m.
7 a.m.
8 a.m.
9 a.m.
10 a.m.
11 a.m.
Close Time:
Choose a time
Noon
1 p.m.
2 p.m.
3 p.m.
4 p.m.
5 p.m.
6 p.m.
7 p.m.
8 p.m.
9 p.m.
10 p.m
11 p.m
Midnight
1 a.m.
2 a.m.
3 a.m.
4 a.m.
5 a.m.
6 a.m.
7 a.m.
8 a.m.
9 a.m.
10 a.m.
11 a.m.
Special Instruction:
Purchase Order #:
Confirmation:
Yes
No
Billing Information *
(Name of payor)
Bill To: *
Payor Phone: *
Address: *
City: *
State: *
Zip Code: *
Email Address:
Name of Person E-mailing:
COD Information
COD Amount:
COD FEE:
Prepaid
COD
US
Canadian
Note - Consignee's company check made payable to the Shipperwill be accepted by Panama and forwarded to shipper unless otherwise directed to do so by the shipper.
Note - Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or declared value of the property.
The agreed or delcared value of the property is hereby specifically stated by the shipper to be not exceeding
$
Per
Remit COD To:
Address
City:
State/Province
Zip/Postal code
