C & C Transportation, Inc. thanks you for using our online pick-up service. Should you need any assistance with this form, please contact us at 1-800-285-1847.
[sections labeled in bold indicate required fields]
Your Name:  
Company Name:  
Department:
Phone:  
Fax:
Email Address:

Company:  
Contact Name:  
Department:
Phone:  
Fax:
Address:  
City:  
State:  
Zip:  
Location:   Business      Residential
Pick-Up Date:  
Ready Time:  
Close Time:  
Reference or Release
Number:		  

Company:
Contact Name:  
Department:
Phone:  
Fax:
Address:  
City:  
State:  
Zip:  
Location:   Business      Residential
Delivery Date:
Receiving Hours:  
PO or Reference #  

Commodity:
Number of Pieces: pcs.
Number of Pallets:
Weight:   lbs.
Class:
NMFC# :
Description of Commodities:

Equipment Required:
  Van Flatbed Air-Ride
Refrigerated Straight Truck Other
Service Required:
  Air Ground Intermodal
Service Time Request:
  Standard Next Day  
Second Day Other (specify below)  
 
Requirements:
Lift Gate Required Temperature Controlled  
Oversized Pallets Double Stackable
     Pallets		 Hazardous Material
Specify Dimensions: Length
Width
Height
  Prepaid Collect  
Company:  
Name:  
Title:
Phone:  
Fax:
Address:  
City:  
State:  
Zip:  
 

If you need any assistance with this form, please contact us toll free at:
1-800-285-1847. We will be glad to assist you.

By sending this electronic pick-up form, you are certifying that you represent one of the legally involved parties of the shipment.

 

 
   

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