Shipper: |
| Name: |
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| Company (if applicable) : |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Country: |
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| Phone Day: |
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| Fax: |
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| E-mail: |
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Consignee: |
| Name: |
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| Company (if applicable) : |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Country: |
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| Phone Day: |
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| Fax: |
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| E-mail: |
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Description: |
| Rate Quoted: |
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| Shipping Date: |
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Destination Port
Shipping to: |
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| Type of Service Desired (Container or Roll-on-off): |
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| Commodity Description (Year, Make, Model, Colour): |
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- (Please note vehicle must not have more than ¼ tank full of fuel or drainage charges will apply).
- If there is a lien on the vehicle we must have an original Lien Release Letter from the lien holder.
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| Is Vehicle Operable |
Yes
No |
Approximate Weight
of Vehicle: |
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Approximate Value
of Vehicle: |
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Vehicle Location
(City, State): |
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| Do you need us to transport your vehicle from the vehicle location to the port of loading?: |
Yes
No |
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Address where you need Documents
mailed back to: |
| Name: |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Country: |
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| Phone Day: |
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| Marine Insurance (Y/N): |
Yes
No |
| Amount of coverage you are purchasing (in USD) $: |
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| Total Purchase Price Quoted (in USD) $: |
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| TOTAL COST |
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| LESS DEPOSIT: |
$250.00 |
| BALANCE DUE |
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| CLIENTS NAME |
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E-Mail: ultimateinc@bellsouth.net |