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CENTERSTAGELOGISTICS, LLC
E-Z SHIP FORM AND CALCULATOR

Company:
Address:
City,State,Zip
Contact Phone
Contact Fax
Contact Name
Title
Contact E-mail
OVER HEIGHT AND OVER WEIGHT PLEASE CALL FOR RATE
NOTE: (Updated Daily) All Rates Based On US Average Per Gallon Fuel Cost of $4.159
Trailer Type: Flatbed, Stepdeck, Van, Refer, RGN/LO-BOY
Pickup Date           Format: mm/dd/yyyy
Origin Contact Name
Origin Contact Phone
Origin Address
Origin Point City, State
Desination Contact Name
Desination Contact Phone
Desination Address
Destination Point City, State
Loaded Miles       LINK TO LOADED MILES CALCULATOR
Full or Partial Load: Full Partial
Oversize Load? Yes No
Enter Length of Load in Feet     Example: 120 Inches = 10 Feet
Weight     Example: 10500 Pounds = 10.5
Enter Width of Load in Inches     Example: 102 Inches
Enter Height of Load in Inches     Example: 102 Inches
Tarped Yes No
TWIC Card Required? Yes No
Permits Required?   If yes, how many States? YesNo
Pilot Cars Required?   If yes, how many? For how many miles? YesNo
Extra Picks and Drops?   If yes, how many? YesNo
Brief Description of Product or Load Comments:
Enter your pro # for a 2% discount
Shipper # If one has been assigned to you
Cost to Move Your Shipment Based on Above Criteria... $
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PLEASE CALL TOLL FREE 855-239-7447 FOR QUESTIONS OR HELP
CHECK IF YOU HAVE READ AND AGREE TO SHIPPING CONTRACT
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