PNW Freight Pickup Form

Please complete all required fields!

PNW Quote Number

Invalid Input

---

Contact Information

---

 

Business Name(*)

Invalid Input

Contact Name(*)

Invalid Input

Telephone Number(*)

please enter in this format: 123-456-7890

Email Address(*)

Invalid email address

Street Address(*)

Please Enter Street Address

City(*)

Enter the City Name

Province(*)

Enter the Province

Postal Code(*)

Please Enter the Postal Code

---

Item Details

---

Item 1

Number of Pieces(*)

1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950 Invalid Input

Type of Freight(*)

Choose one...BoxBundleCase Carton CrateCylinderDrumSkidPieceRollTirePupTruckload Invalid Input

Indicate if any of the following apply:

FreshFrozenHeat Required Invalid Input

Dangerous Goods?

YesNo Please choose "yes" or "No"

Weight(*)

Invalid Input - numbers only

Lbs or Kgs(*)

LbsKgs choose lbs or kgs

Length (in.)(*)

Invalid Input

Width (in.)(*)

Invalid Input

Height (in.)(*)

Invalid Input

Description

Invalid Input

---

 

Item 2
(optional)

Number of Pieces

01234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950 Invalid Input

Type of Freight

Choose one...BoxBundleCase Carton CrateCylinderDrumSkidPieceRollTirePupTruckload Invalid Input

Indicate if any of the following apply:

FreshFrozenHeat Required Invalid Input

Dangerous Goods?

YesNo Please choose "yes" or "No"

Weight

Invalid Input - numbers only

Lbs or Kgs

LbsKgs choose lbs or kgs

Length (in.)

Invalid Input

Width (in.)

Invalid Input

Height (in.)

Invalid Input

Description

Invalid Input

---

 

Item 3
(optional)

Number of Pieces

01234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950 Invalid Input

Type of Freight

Choose one...BoxBundleCase Carton CrateCylinderDrumSkidPieceRollTirePupTruckload Invalid Input

Indicate if any of the following apply:

FreshFrozenHeat Required Invalid Input

Dangerous Goods?

YesNo Please choose "yes" or "No"

Weight

Invalid Input - numbers only

Lbs or Kgs

LbsKgs choose lbs or kgs

Length (in.)

Invalid Input

Width (in.)

Invalid Input

Height (in.)

Invalid Input

Description

Invalid Input

---

 Pickup Date and Time

---

 

Pickup Date and Time(*)

Invalid Input

Notice:(*)

By checking this box, the shipper acknowledges that any orders scheduled for pick up that are not ready upon arrival will be charged a cold call charge of $75.00 Invalid Input

(*)

Invalid Input

Submit