Supreme Moving Ltd.

Customer Information *-Fill in all required fields

First Name*		Last Name*
Company Name		Job Position
Street
City		Province/State
Country		Postal / Zip Code
Tel No.*		Fax No.
Cell No.		Email*

Shipment Information
Origin of Cargo		Destination of Cargo
Estimated Total Volume		Estimated Total Weight
Mode of Transport		Service Required
Shipment Category		Total Number of Pieces
Weight Per Item in	kg lb
Dimension Per Piece (LXWXH) in	ft meter

Vehicle (if applicable) (Specify make, model and year)		Heavy Equipment (if applicable) (Specify LXWXH and Weight)
Declared Value		Insurance

Pickup and Delivery Info
Pickup Date		Delivery Date
Pickup Address Stairs Required to Reach Destination		Delivery Address Stairs Required to Reach Destination
Comments
Special Instructions