Load Information Sheet by z30g074

VIEWS: 4 PAGES: 1

									                           Load Information Sheet
                         Load Number ___________
Date:           _____________________
Client Name:    _____________________
Client Phone:   _____________________
Client Fax:     _____________________

Pickup Information                      Delivery Information

1. Name:        ___________________     1. Name:        ___________________
Address:        __________________      Address:        __________________
City, State, Zip:                       City, State, Zip:
Phone #:        ___________________     Phone #:        ___________________
Hours:          ___________________     Hours:          ___________________
Contact Person: ___________________     Contact Person: ___________________
Special Instructions: ______________    Special Instructions: ______________


Pickup Information                      Delivery Information

2. Name:        ___________________     2. Name:        ___________________
Address:        __________________      Address:        __________________
City, State, Zip:                       City, State, Zip:
Phone #:        ___________________     Phone #:        ___________________
Hours:          ___________________     Hours:          ___________________
Contact Person: ___________________     Contact Person: ___________________
Special Instructions: ______________    Special Instructions: ______________


Pickup Information                      Delivery Information

3. Name:        ___________________     3. Name:        ___________________
Address:        __________________      Address:        __________________
City, State, Zip:                       City, State, Zip:
Phone #:        ___________________     Phone #:        ___________________
Hours:          ___________________     Hours:          ___________________
Contact Person: ___________________     Contact Person: ___________________
Special Instructions: ______________    Special Instructions: ______________




   Load Information:
          Flat Rate:               $
          Add’l Authorized Charges:$       Reason:
          Total Agreed Amount: $

								
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