Carrier Rate Confirmation Carrier Load Confirmation Today's Date * Pro Number Carrier Email Address * Shipper Name * Address * Address City * State * Zip * Contact Name * Phone Number * Contact Fax Number Shipper Reference Number Consignee Name * Address * Address City * State * Zip * Contact Name * Phone Number * Contact Fax Consignee Reference Number Shipping Information Note: For hazardous materials be sure to enter the proper shipping name, hazard class, ID number, and packing group. Equipment * (Choose One) Van Flatbed Step Deck RGN Double Drop Stretch Trailer Conestoga Cargo Van Straight Truck Intermodel Other Equipment Tarp? * Yes No Expedited? * Yes No Exclusive? * Yes No Team Driver? * Yes No Freezable? * Yes No Hazardous? * Yes No Other? If over $100,000 do you require excess Cargo Insurance? Yes No Cargo Value $ Commodity / Description: * Dimension Length (ft/in) Dimension Width (ft/in) Dimension Height (ft/in) Units: Weight: * UN Number: Haz Class: Packaging Group: NMFC Number: Class: Carrier Special Pick Up Instructions * Carrier Special Delivery Instructions * For Haz Mat Only Contact Name: Emergency Response Number: Special Instructions Carrier Information Carrier Name: * Carrier Address: * Carrier Address: Carrier City: * Carrier State * Carrier Zip * Carrier Contact Name: * Carrier Contact Email Address * Single Line Text Carrier Phone Number * Total Carrier Pay * Proof of Delivery Requirements: Delivery Date, Time of Arrival / Departure from both Shipper / Consignee, Signatures of Shipper, Carrier's Driver, and Consignee. Consignee signature both print and written. Agent Contact * Agent Confirm Date * Carrier Contact * MC# / FID# * Carrier Fax * Carrier Confirm Date * Terms & Conditions: The following documents are required to process payment: a. Invoice b. Bill of Lading c. Legible Proof of Delivery d. And THIS signed Load Confirmation. Carrier or Carrier's driver must submit Proof of Delivery within 72 hours of delivery via fax or email. Fax: 906-774-1993 Email: email@example.com. Billing Questions? Contact: 800-821-6389 Load/Rate Questions? Contact: 800-952-7848 or firstname.lastname@example.org. If you are human, leave this field blank.