Circle City Transport, Inc.

Rate Quote Request

To obtain a rate quote for your U.S. domestic shipment, complete the following information. A prompt reply will be returned to you.

Circle City Transport, Inc authorizes its customers to use the DOMESTIC RATE QUOTE feature to obtain pricing information for future shipments. Any use of DOMESTIC RATE QUOTE other than for potential movement of freight within Circle City Transport, Inc. lanes is prohibited. For additional pricing information, please call our Account Management Center at 1(800)239-8878.

Your First Name:

Your Last Name:

Company:

Address: 1

Address: 2

City:

State:

Zip:

Phone:

Fax:

E-mail:

Would you like us to E-mail , Fax or Phone your rate quote back to you?

Shipment Information

Origin City:

Origin State:

Origin Zip:

Destination City:

Destination State:

Destination Zip:

WHO IS PAYING THE FREIGHT CHARGES?

Shipper Receiver Third Party

Projected Ship Date Declared Value Number of Shipments

Month Day Year

Shipment weight (in pounds) Trailer Requirements Trailer Size in Feet

Special Requirements or Instructions

Commodity Description

HOW IS THE SHIPMENT PACKAGED?

Palletized Loose packages Slip Sheet

Loading Method?
Driver Load	Shipper Load
Unloading Method?
Driver Unload	Destination Unload

Hazardous Material?
yes	no

If Yes to Hazardous Please Describe Material as well as UN number.

IMPORTANT: Be sure to check the accuracy and completeness of your request prior to submitting it. All above fields are mandatory except:

Special Requirements and or Instructions

You must enter your fax number or your E-mail address, but you do not need to enter both.