Pickup Request

Fill out the form below and submit it to FMI for a rate quote request.
We will contact you by phone to discuss your shipment needs and options.

Contact Information
Company Name
Contact Person
Phone Number
Email Address


Origin & Destination Information
ORIGIN
ZIP/Postal Code
Business: Pickup at Loading Dock
Business: Pickup without Loading Dock
Residence/Non-commercial
Construction Site
Tradeshow/Convention Center 		DESTINATION
ZIP/Postal Code
Business: Delivery at Loading Dock
Business: Delivery without Loading Dock
Residence/Non-commercial
Construction Site
Tradeshow/Convention Center


Type of Package
Single item or handling unit
Multiple items, products or handling units


Quantity
Quantity
Said to contain: pieces per handling unit


Gross Weight
lbs.
kilos 		(Gross weight includs the weight of the pallets, packaging, etc.)


NMFC, or Equipment Size, or Dimensions
NMFC Class
NMFC Note 		Equipment Size

Equip Size Note 		Dimensions
Length Width Height
select one
inches     cm


Type of Equipment
Van    Reefer    Flat    Specialized


Commodity


Service Details
Additional Services
Hazardous material
Blind Shipment
Protective Service
Collect on delivery (COD)/Billing Options
Notify receiver prior to delivery

Date of Pickup
After 3pm, please schedule pick up for next day

Shipment Ready Time
Please allow a four hour pick-up window.
Please note that pickups are commonly done in the afternoon hours.
Ready After: Ready Before:
Freight Management, Inc., 2198 Gladstone Ct., Suite D, Glendale Heights, IL 60139
Phone 630-627-6560    Fax 630-627-7026
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