WWEX VENDOR SHIPMENT Please enter data in all required fields below denoted with an asterisk (*). Please ensure that the customer account number of the responsible Worldwide Express customer is accurate. "*" indicates required fields FREIGHT BOOKING REQUESTCompany Name*Account Number*Your Email*Your Phone #*ORIGINOrigin Company Name*Origin Address (line 1)*Origin Address (line 2)Origin City*Origin State*SelectAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificAlberta (AB)British Columbia (BC)Manitoba (MB)New Brunswick (NB)Newfoundland and Labrador (NL)Nova Scotia (NS)Northwest Territories (NT)Nunavut (NU)Ontario (ON)Prince Edward Island (PE)Quebec (QC)Saskatchewan (SK)Yukon (YT)Origin Zip/Postal Code*Origin Country*SelectUnited StatesCanadaMexicoOrigin Contact Name*Origin Contact Phone*Origin Contact EmailDESTINATIONDestination Company Name*Destination Address (line 1)*Destination Address (line 2)Destination City*Dest. State*SelectAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificAlberta (AB)British Columbia (BC)Manitoba (MB)New Brunswick (NB)Newfoundland and Labrador (NL)Nova Scotia (NS)Northwest Territories (NT)Nunavut (NU)Ontario (ON)Prince Edward Island (PE)Quebec (QC)Saskatchewan (SK)Yukon (YT)Dest. Zip/Postal Code*Dest. Country*SelectUnited StatesCanadaMexicoDestination Contact Name*Destination Contact PhoneDestination Contact EmailSHIPMENT INFORMATIONPlease note: Carriers require a two-hour span of time between ready and close times. Shipments scheduled for same-day pickup after 3 PM may be automatically pushed to the next business day.Ready Date* MM slash DD slash YYYY Ready Time* Hours : Minutes AM PM AM/PM Close Time* Hours : Minutes AM PM AM/PM Do you need a guaranteed delivery date? Yes No Date MM slash DD slash YYYY Time Hours : Minutes AM PM AM/PM Does this shipment need insurance? Yes No Value of shipment*Condition of goods* New Commercial Goods Used, Rebuilt or Refurbished Goods Is this shipment international? Yes No Broker Company or NameBroker ContactBroker PhoneBroker Address Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Reference required at pickup? Yes No Reference NumberOrigin Services Inside Pickup Liftgate at Pickup Residential Pickup Non-Commercial Location Other Destination Services Inside Delivery Liftgate at Delivery Residential Delivery Appointment / Notification Delivery Other Other Origin ServiceOther Destination ServiceNotes/Additional ReferencesHANDLING UNIT / ITEM DETAILS Handling Units# of Units*Type*SelectPalletSkidBagBaleBarrelBasketBinBoxBunchBundleCabinetCanCarboyCarrierCartonCaseCaskContainerCrateCylinderDrumJerricanLoosePackagePailPiecesPipe LineReelRollSpoolTankTotesTubTubeUnitVan PackWrappedOtherStackable*SelectYesNoUnit Length*Unit Width*Unit Height* ItemsPiece CountPiece TypeSelectPalletSkidBagBaleBarrelBasketBinBoxBunchBundleCabinetCanCarboyCarrierCartonCaseCaskContainerCrateCylinderDrumJerricanLoosePackagePailPiecesPipe LineReelRollSpoolTankTotesTubTubeUnitVan PackWrappedOtherTotal Weight*Class*-505560657077.58592.5100110125150175200250300400500NMFCHazmat?*-YesNoProper Shipping NameUN-UNNAIDUN #PKG-IIIIIINoneHazmat Class-1.11.1G|Second Choice1.2|Third Choice1.2G1.31.3G1.41.4G1.4S1.51.62.12.22.333(6.1)3(8)4.14.24.34.3(3)(8)4.3(8)(3)5.25.1(8)5.16.16.1(3)6.1(5.1)6.1(8)6.1(8)(3)6.2788(3)8(5.1)8(6.1)9N/AContact Name/PhoneCommodity Description*Add ItemRemove ItemMaximum of 20 ItemsAdd Handling UnitRemove Handling UnitMaximum of 20 Handling Units Δ
