M e x p r e s s t r a n s p o r t a t i o n, i n c.

	Reference:
		CONTACT INFORMATION
	LEGAL BUSINESS NAME:
	Your Name:
	Company:
	Account?
	Area/Phone:	Ext:
	E-mail:

		PICK-UP LOCATION
	WHERE FROM?
	Contact:
	Company:
	Area/Phone:	Ext:
	Address:

	City/State:	Zip:
	Province:
	Country:
		CUSTOMS INFORMATION
	Port of Entry:
	Mexican Broker:
	Area/Phone:	Ext:
	U.S. Broker/ Forwarder:
	Area/Phone:	Ext:
	Comments/ Additional Information:
		SHIPMENT DESTINATION
	WHERE TO?
	Contact:
	Company:
	Area/Phone:	Ext:
	Address:

	City/State:	Zip:
	Province:
	Country:

		SHIPMENT DESCRIPTION
	DESCRIPTION
	P/U Date:	Qty. Shipments:
	P/U by:	a.m.p.m.
	Pieces:	cartons crates drums pallets reels rolls other: Total pieces:
	Description:
	Weight:	Pounds Kilos
	Volume:	Cubic:Feet Meters
	In-bond?	Yes No Hazardous? Yes No
	Terms:	Pre-paid Collect Third Party Account
	Third Party:
	Account:


		Please note that the form will only return properly when the name and email lines have entries. RETURN TO DOWNLOAD PAPERWORK