WA0117 
 

MyPCI Domestic Pickup Request

   
Shipment Type:  Domestic   International Air   Ocean 

Shipper's Information
Date: Shipper's Ref.#:
Shipper:
Street Address:
City: State: Zip:
Contact Name: Telephone#:
Email:
Terms and Conditions of Service
Consignee's Information
Consignee's Ref.#:
Consignee:
Street Address:
City: State: Zip:
Contact Name: Telephone#:
Email:
                       

Service Description:  Next Day   2nd Day   Economy (3-5 Day)   Next Flight Out   

Form of Payment
 Bill Shipper
 Bill Consignee
  Third Party Bill to Company




 

Special Instructions
Liablity for the Forwarder is limited to $.50 per pound of that part of the consignment lost, damaged, or delayed. The Forwarder will maintain a cargo liability insurance policy with an insurance company to cover such liability. Indicate amount to be insured in box marked "Amount of insurance".
Amount of Insurance:

Total Pieces
Description of Packing and Contents
Total Weight
 

Requested Pickup Time Date:    Time:  

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