Ship From


Supplier/Shipper:*

Company Name or Individual

Point of Contact:*

First & Last Name of On-Site Contact

Pickup Address:*

US Format Only

Phone:*

Email:*

username@domain.com

Shipper Reference #:

ex: Supplier's Ref. Quote #. If none, leave blank

Special Instructions For Shipper:

ex. Special Pick up Hours between 0400 - 1800

Ready Date:*

Est. Date of PIckup

Pick-up Ready Time:*

in 30 min increments

Deliver To


Ship To/Consignee:*

Company Name or Individual

Receiver Contact:*

First & Last Name of On-Site Contact

Deliver To Address:*

US Format Only

Phone:*

Email:*

username@domain.com

Special Instructions For Delivery:

ex. Special Delivery Hours between 1700 - 1900

Required by Delivery Date:*

Required Delivery Time:*

in 30 min increments

Order Details


I would like to request Most Expedited or White Glove Service:*

RMA

Vendor Name

Goods Detailed Description :*

Does this shipment require insurance?

Estimated Shipment Value*

$

Qty *

UOM *

Dimensions (L x W x H) *

Actual Weight *

Calc. Total Actual Weight

Calc. Total Dim. Weight

Quantity
Unit of Measure
Length (IN)
Width (IN)
Height (IN)
Per Unit Weight
U.S Standard
Formula: QTY x Actual Weight
Formula: LxWxH/166 x QTY

Hazmat Information


Is this Hazmat?*

If "Yes", Please Provide UN# or Description

Upload Safety Data Sheet:

Choose files or drag here

Accounting Details


Is this Billable to a GCI business client?*

If "Yes", Please specify GCI Client Info:

Project Name:

Account No. or Project.Task Code:*

A Valid Account Code is *REQUIRED* To Proceed with Payment & Booking.

Move Order #:*

If no MO#, type N/A. If multiple, separate them by commas.

Purchase Order #:*

If no PO#, type N/A. If multiple, separate them by commas.

ER #:*

If no ER#, type N/A. If multiple, separate them by commas.

Upload Shipping Document:

(i.e. PO, 9010, packing list, etc.)
Choose files or drag here

Cherwell Ticket #:

Any additional Documents:

Choose files or drag here

GCI Internal Notes:

Visibility: GCI Reports Only. (Will not appear on Shipment Documents, Housebills, etc.)

Confirm & Verify


Booking Prepared By:*

You will receive a confirmation summary upon approval.

Preparer's Email:*

username@domain.com

Requester:*


Requester's Email:*

username@domain.com

Carbon Copy 1:

username@domain.com One email recipient per field*

Carbon Copy 2:

username@domain.com One email recipient per field*

Carbon Copy 3:

username@domain.com One email recipient per field*

Carbon Copy 4:

username@domain.com One email recipient per field*

Carbon Copy 5:

username@domain.com One email recipient per field*

Carbon Copy 6:

username@domain.com One email recipient per field*