POTENTIAL CUSTOMER QUESTIONNAIRE

This form is designed to help us get a rate for you as soon as possible. In order for us to do this, we need you to fill out this Questionnaire COMPLETELY. If it is not filled out completely we cannot possibly get you a rate. All information is necessary to get a competitive rate. If you have any question, or do not have all the needed information, please contact us. Thank you for giving us the opportunity to help you with your transportation needs.

Today's Date
Today's Date
Shipper Info
Shipper Address *
Shipper Address
Shipper Phone
Shipper Phone
Origin Info
Origin Phone
Origin Phone
Receiver Info
Receiver Address *
Receiver Address
Receiver Phone
Receiver Phone
Destination
Shipments would begin on
Shipments would begin on
Prepaid or Collect
Inbound or Outbound
Does car need to be weighed?
Do you have rail siding or spur?
Phone
Phone
Fax
Fax