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Pickup Request

Requester Affiliation

I am the (select all that apply)

Shipper Consignee Third Party

Payment Terms

Requester Information

Name

Phone

Extension

Origin

Company Name

Call to Arrange Pickup

Care Of

Street Address

Country

Zip or City, State

Contact Name

Extension

Pickup Information

Pickup Date

Available By Time

Business Opening Time

Closing Time

Pro Number

Check Digit

Quote ID

Linear Feet

Instructions

Consignee

Company Name

Care Of

Street Address

Country

Zip or City, State

Contact Name

Phone

Extension

Email Address

Third Party

Company Name

Care Of

Street Address

Country

Zip or City, State

Contact Name

Phone

Extension

Commodities

Handling Unit Type

Count

Weight

Class

NMFC Item

Sub

Package Type

Quantity

Cube

Hazardous

Description

Reference Numbers

PO Numbers

Pieces

Weight

Department

CRN/Return#

Pickup

Liftgate-Ground Pickup Residential Pickup Inside Pickup Limited Access Pickup TruckPack Boxes Secure Shipment Divider Trade Show Pickup

Delivery

Liftgate-Ground Delivery Residential Delivery Inside Delivery Limited Access Delivery Arrival Notification Construction Site Delivery Flatbed Delivery Delivery On Trade Show Delivery

Other

Time-Critical Shipment Do Not Stack Single Shipment Sort & Segregate Freeze Protection Capacity Load Excess Liability Coverage Over Dimension

Send Copy/Confirmation To

Send copy of this Pickup Request to

Origin Destination Third Party Other

Send confirmation when shipment is picked up to

Origin Destination Third Party Other

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Support center 24/7

201-331-6873

You can find us at

Parsippany-Troy Hills, NJ 07054

Get in touch with us

contact@universalmobility.com

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Universal Mobility is your single-source solution for all your logistics needs. In North America.

Support center 24/7

201-331-6873

You can find us at

343 NEW ROAD , UNIT #4 PARSIPPANY NJ 07054

Get in touch with us

contact@universalmobility.com