Documents

Import Request

 

ORDER FORM - IMPORT REQUEST
           
                 
PLEASE FAX - OR SUBMIT TO:
EXPRESS SOLUTIONS NV
FAX # +32 - (0)2 - 753 05 59 - bru@ex-sol.com
   
   
Dear Sirs,  
Please pick up, in our name and for account (transport charges for our account),
undermentioned shipment with given details  
   
ATTENTION !!! Shipper must be made aware of below instructions !!
   
   
PICK-UP DATE :  
   
   
PICK-UP ADDRESS (Shipper) :  
   
COMPANY NAME:  
ADDRESS:  
   
   
   
   
CONTACTNAME:  
PHONE NUMBER:  
   
EMAIL ADDRESS
   
DELIVERY ADDRESS (Consignee) :  
 
COMPANY NAME:  
ADDRESS:  
   
   
   
CONTACTNAME:  
PHONE NUMBER:  
   
   
SHIPMENT INFORMATION:    
 
DETAILED DESCRIPTION OF CONTENTS:  
# OF PARCELS:  
WEIGHT:  
DIMENSIONS:  
   
VALUE & CURRENCY:  
INSURANCE: YES / NO  
   
   
I, declare that all given details on this shipment are true and correct and that to my best knowledge,
no forbidden and/or dangerous items are packed inside this shipment.
                 
COMPANY (principal) + NAME Signature: