Your Full Name *: Mrs.Mr.Miss.Ms.Dr. Company Name: (If Applicable) Email *: Working Phone Number *: Daytime Work #Daytime Home #Evening Work #Evening Home #Cell Phone # Extension: Address Line 1 *: Address Line 2: City *: State/Province *: Zip/Postal Code *: Country *: United States of AmericaCanadaAbu Dhabi (United Arab Emirates)Admiralty Islands (Papua New Guinea)AfghanistanAitutaki (Cook Islands) (New Zealand)Ajman (United Arab Emirates)Aland Island (Finland)AlbaniaAlderney, Channel Islands (Great Britain)AlgeriaAlhucemas (Spain)Alofi Island (New Caledonia)American SamoaAndaman Islands (India)AndorraAngolaAnguillaAnjouan (Comoros)Annobon Island (Equatorial Guinea)Antigua and BarbudaArgentinaArmeniaArubaAscensionAstypalaia (Greece)Atafu (Western Samoa)AustraliaAustriaAvarua (New Zealand)AzerbaijanAzoresAzores (Portugal)BahamasBahrainBaker Island (US Possession)Balearic Islands (Spain)Baluchistan (Pakistan)BangladeshBanks Island (Vanuatu)BarbadosBarbuda (Antigua and Barbuda)Barthelemy 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Possession)Santa Cruz Islands (Solomon Island)Sao Tome and PrincipeSarawak (Malaysia)Sark, Channel Islands (Great Britain)Saudi ArabiaSavage Island (Niue) (New Zealand)Savaii Island (British) (Western Samoa)Scotland (Great Britain and Northern Ireland)Selangor (Malaysia)SenegalSerbia-MontenegroSeychellesSharja (United Arab Emirates)Shikoku (Japan)Siam (Thailand)Sierra LeoneSikkim (India)SingaporeSlovak RepublicSloveniaSociety Islands (French Polynesia)Solomon IslandsSomali Democratic Republic (Somalia)SomaliaSomaliland (Somalia)South AfricaSouth Australia (Australia)South Georgia (Falkland Islands)South Korea (Korea, Republic of)South-West Africa (Namibia)SpainSpitzbergen (Norway)Sri LankaSt. Eustatius (Netherlands Antilles)St. Maarten (Netherlands Antilles)St. Martin (Guadeloupe)Ste. Marie de Madagascar (Madagascar)SudanSurinameSuwarrow Islands (New Zealand)Swain's Island, American Samoa (US Possession)Swan Islands (Honduras)SwazilandSwedenSwitzerlandSymi (Greece)Syrian Arab RepublicTahaa (French Polynesia)Tahiti (French Polynesia)TaiwanTajikistanTanzaniaTasmania (Australia)Tchad (Chad)ThailandThursday Island (Australia)Tibet (China)Tilos (Greece)Timor (Indonesia)Tinian, Northern Mariana Islands(US Possession)Tobago (Trinidad and Tobago)TogoTokelau (Union) Group (Western Samoa)TongaTongareva (New Zealand)Tori Shima (Ryukyu Islands) (Japan)Torres Island (Vanuatu)Trans-Jordan (Hashemite Kingdom) (Jordan)Transkei (South Africa)Trengganu (Malaysia)Trinidad and TobagoTripolitania (Libya)Tristan da CunhaTrucial States (United Arab Emirates)Truk (See Chuuk Island)Tuamotou (French Polynesia)Tubuai (French Polynesia)TunisiaTurkeyTurkmenistanTurks and Caicos IslandsTutuila Island, American Samoa (US Possession)TuvaluU.S. Virgin IslandsUgandaUkraineUmm al Quaiwain (United Arab Emirates)Umm Said (Qatar)Union Group (Western Samoa)United Arab EmiratesUnited Kingdom (Great Britain)United Nations, New YorkUpolu Island (Western Samoa)UruguayUzbekistanVanuatuVatican CityVenezuelaVictoria (Australia)VietnamVirgin IslandsWake IslandWales (Great Britain and Northern Ireland)Wallis and Futuna IslandsWellesley, Province (Malaysia)West New Guinea (Indonesia)Western Australia (Australia)Western SamoaYap, MicronesiaYemenZafarani Islands (Spain)ZambiaZanzibar (Tanzania)Zimbabwe Description of Products *: Any special needs (check any and all required): Dangerous Goods (HazMat)PerishableHigh Value (Precious Gems, Jewelry, Currency, etc.)Live Animals
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Pickup Location * (city / state or province / zip or postal code / county): Shipment Pickup Date *: MM/DD/YYYY Format Delivery Location * (city / state or province / zip or postal code / county): Shipment Delivery Date *: MM/DD/YYYY Format Type of Service Required (click on one): AirOceanTruck (TL)Truck (LTL)RailSmall Package (Air Courier or Local Messenger as required)I am not sure Type of Shipment Required (click on one): DomesticInternational (an international shipment that requires domestic transportation as well is considered an international shipment) Packaging Requirements (pick one only): Bulk FreightBreakbulk Freight (odd shape - wood or other customized crating required)Containerized Ocean Freight (20' or 40' foot ocean container)Containerized Air Freight (LD3, LD7, etc.)I am not sure Must be packaged by outside company prior to shipment?: YesNoI am not sure Comments, or anything else relevant to this shipment? Please comment below.: Please fill out the CAPTCHA before sending *:
