Pickup Request
= Required Field
Shipper Information Contact Information
 Contact Name:  Contact Name:
 Shipper Name:  Company Name:
 Address:  Phone, Ext:
()  -       
 City, ST, Zip:  Email:
 Phone, Ext:
()  -       
 Please fill out contact info if different
from Shipper Information.
 Email:
Pickup Information
 Pickup Date:  Destination Zip:
   
 Ready Time:  Total Weight: (Lbs.)
:  
 Shipping Dept. Closing Time:  Total Pieces:
:  
 Additional Comments, Instructions:
  
Questions?
Questions?   Call Customer Service: 1-800-543-5589
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R+L Carriers is a Smartway recognized carrier.
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