REQUEST FOR PICKUP:

PLEASE COMPLETE THE INFORMATION BELOW THEN CLICK SUBMIT.  FORT PITT WILL CONFIRM LOAD STATUS  VIA EMAIL OR PHONE.

YOUR NAME:
COMPANY NAME:
COMPANY CODE:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
FAX:
EMAIL:

NOTIFICATION OF REICEIPT BY :    EMAIL , FAX OR PHONE

LOAD INFORMATION:

PICKUP DATE & TIME:
EQUIPMENT SIZE: 20 40 45 48 53
MODE: INTERMODAL OVER THE ROAD
SHIPPER NAME:
LOADING ADDRESS:
CITY, STATE, ZIP:
CONTACT & PHONE NUMBER:
PICKUP NUMBER IF NEEDED:
PO#, BILL OF LADING NUMBERS:
ANY OTHER SPECIAL INSTRUCTIONS:
CONSIGNEE NAME:
DELIVERY ADDRESS:
CITY, STATE, ZIP:
CONTACT:
PHONE NUMBER:
PO#’S:
SPECIAL INSTRUCTIONS:
COMMODITY:
BILLING:  PREPAID OR COLLECT
BILLING NAME:
ADDRESS:
CITY, STATE, ZIP:
BILLING REFERENCE: