Erb Interactive | Order Entry

Order Entry

Order Number: Requested Service: Freight Terms:

Caller	Shipper Same as Caller	Pickup At Same as Shipper	Consignee Same as Caller	Destination Same as Consignee
Company: Name: Address: City: Provice/State: Postal/ZIP Code: Phone: Contact:	Company: Name: Address: City: Provice/State: Postal/ZIP Code: Phone: Contact:	Company: Name: Address: City: Provice/State: Postal/ZIP Code: Phone: Contact:	Company: Name: Address: City: Provice/State: Postal/ZIP Code: Phone: Contact:	Company: Name: Address: City: Provice/State: Postal/ZIP Code: Phone: Contact:

Commodity:

Temperature:

Pieces*:

Pallet Spots*:

Weight*:

Freight:

Requested Equipment for Pickup:

Declared Value:

Customs Broker City/St-Prov:

Customs Broker Name:

Requested Pickup Date: Pickup Time: Close Time: P/U Appointment Required

Scheduled Delivery Date: Must arrive by Date: Calculate Delivery Date (MB/ON/QC)

Bill of Lading #: Purchase Order #:

Reference #:

To ensure same day pickup or delivery appt request, must be received by 10 AM EST. All other freight must be received by 12 NOON EST