Landstar, Canton, OH, Truckload, Supply Chain Logistics, Warehouse Services

Note: Fields with an asterix (*) are required

Requestor Information

*Name (First, Last) :

*Company:

*Phone:

(Please include area code)

*Fax:

(Please include area code)

*E-Mail Address:

*Are you currently a Landstar customer?

Yes

Please provide some details to define your shipment criteria:

*Mode:

	Air
	Ocean

	Import
	Export
	Domestic

Terms of sale and cargo value:

*Payment terms:

	Prepaid
	Collect
	Third Party

If Third Party, please provide Bill To information:

Company Name:
Address:
City :
State :
Country :
Postal Code :
Contact :
Phone :

Please indicate any known INCOTERMS:

*Value of Cargo (USD):

*Is additional liability coverage required on this amount?:

	Yes
	No

Service details :

	Door to Door
	Door to Port/Airport
	Port/Airport to Door
	Port/Airport to Port/Airport

*Expected Ship Date:

Select Date

Is this commodity/shipment current or new business for you?

	New
	Current

Reference number/Quote #

If you would like to add your own reference # as a way to refer to this specific quote, please enter it here:

Shipment Details

*Shipping Facility Name:

*Shipper Address:

*Shipper City:

*Shipper State:

*Shipper Country:

*Shipper Postal Code:

Shipper Contact:

Shipper Phone:

*Consignee Company Name:

*Consignee Address:

*Consignee City:

*Consignee State:

*Consignee Country:

*Consignee Postal Code:

Consignee Contact:

Consignee Phone:

*Service Level:

Domestic Air
	Overnight
	2nd Day
	Charter

International Air
	Express
	Express Door-to-Door
	Airport-to-Airport
	Charter

Enter dimensions (in inches) and weight for each piece:

*Number of pieces:		Length:		Width:
		Height:		Weight:	( note if kilo or lb )

*Number of pieces:		Length:		Width:
		Height:		Weight:	( note if kilo or lb )

*Number of pieces:		Length:		Width:
		Height:		Weight:	( note if kilo or lb )

*Number of pieces:		Length:		Width:
		Height:		Weight:	( note if kilo or lb )

*Number of pieces:		Length:		Width:
		Height:		Weight:	( note if kilo or lb )

*Ready time at Shipper facility (time and date):

Select Date

*Closing time at Shipper facility:

*What are the specific contents of this shipment?:

*Are there any contents considered hazardous or dangerous by air per government regulations?:

*Are there any special handling requirements? COD, Appointment, Residential, Hotel, etc…(Accessorial and Regulatory items):

*Container Size (if FCL):

	20'
	40'
	45'

*Dimensions in inches and weight for each piece (If LCL):

*Number of pieces:		Length:		Width:
		Height:		Weight:	( note if kilo or lb )

*Number of pieces:		Length:		Width:
		Height:		Weight:	( note if kilo or lb )

*Number of pieces:		Length:		Width:
		Height:		Weight:	( note if kilo or lb )

*Number of pieces:		Length:		Width:
		Height:		Weight:	( note if kilo or lb )

*Number of pieces:		Length:		Width:
		Height:		Weight:	( note if kilo or lb )

*Total Weight of Shipment:

*Port of Loading:

*Port of discharge:

*Description of cargo:

All rate request forms received by 4pm EST will receive the requested rate within the hour. Rate requests are processed Monday thru Friday. All requests received outside of normal business hours, will be responded to within the first hour of the next business day. For immediate service or after hours requests, call us at (330) 484-6013.

For a rate quote or more information about our services, call Secrest Direct, Inc., today at (330) 484-6013 or contact us at jeff.secrest@landstarmail.com.

Contact our transportation service professionals in Canton, OH, for truckload, supply chain logistics, ocean & air cargo service, expedited service, warehouse services and Owner/Operators Wanted.