LCL ORDER FORM

SHIPPER/EXPORTER INFORMATION:

Complete Name of Person who is shipping (same as it appears on the Passport). If married, provide your & spouse

SHIPPER ADDRESS (USA):

CONTACT DETAIL:

PICK-UP REQUEST

TOTAL NUMBER OF PIECES (AT LEAST AN APPROX COUNT)
SR. NO. PALLET/BOXES QTY DIMENSION (L×W×H) WEIGHT LBS/KG

CONSIGNEE/RECEIVER INFORMATION:

Complete mailing address, Consignee, Tel# & email at DESTINATION

(for Bill of Lading Purposes)

Person to receive goods at Destination or Consignee (If different from above):

**INSURANCE – YES or NO (If yes, then give us list of contents with valuation within 7 days from the date of pickup)

**Insurance is optional, and you can buy @ $2.50 per $100 value coverage with Minimum of $250

Total Value of Shipment:

EIN (Employee Identification Number):

(NOTE: Shipment values at USD2500 & above will require for EIN # (Instruction to obtain the number is upon request)

(Shipper Signature)