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Pickup Request Form

Contact Information *Required fields

*SHIPPER Name:
Address:
City:
State: Zip Code:
*SUBMITTED BY Name:
*Submitted by Phone: ext.
*Submitted by email:
*Confirm email:
   
*CONSIGNEE:
*Consignee - City:

*Consignee - State:
*Consignee - Zip:
   
PICKUP Date/Time: Month:   Day:   Year: Time:
*Number of Pallets/Bndls:
*Shipment Weight:
*Trailer Requirements: Trailer Space in Feet: Truckload   LTL
Material Class:
Billing of Lading/Shippers Number:
Line# PO# Part# Quantity
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Line# PO# Part# Quantity
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Special Instructions:
     

 

GEMM Enterprises, Inc.   Suite 2006 Kinvara Drive McKnight East Plaza One   Pittsburgh, PA 15237
1.800.486.4366   412.367.6114   info@gemment.com