Request For Pickup

Air Freight

Please fill out this form to request a pickup from American West Worldwide Express.

Shipper
Shipper / Company Name:	Help?
Your Full Name: (Name of person requesting this pickup)	Help?
Shipper / Company Address:	Help?
City, State and Zip Code:
Shipper / Company Phone and Fax Number: ( in the following format) (123)456-7890	Phn Help? Fax
Extension number (if applicable):
Shipper's email address: (e.g.: you@aol.com)	Help?

Consignee
Consignee name:
Name of Contact Person:
Consignee Address:
City, State and Zip Code:
Bill To Address:
Consignee Phone and Fax Number: (in the following format) (123)456-7890	Phn Help? Fax
Extension Number: (if applicable)

Please provide information about the freight that we are going to pick up.
P.O. Number to Reference
Type of Commodity:
Pickup date:
What time will this pickup be ready?
What time does this pickup location close? (must be within a two-hour window)
Delivery Date:
Number of pieces in this pickup.
Number of pallets in this pickup.
Estimated weight of this shipment.
Dimensions for each piece of freight or pallet.
Please select the type of service level for this pickup.	Air Freight 1 Day Air Freight 2 Day Air Freight 3 Day Air Freight 4-5 Day

Please provide payment information for this pickup.	Shipper Prepaid Consignee Prepaid Shipper C.O.D. Consignee C.O.D. Bill To 3rd Party
Please provide any special instructions for our staff in regards to this pickup request.

Which location should this pickup request be emailed to?	Los Angeles, CA. Dallas / Fort Worth, TX Chicago, IL Columbus, OH

IMPORTANT! You only need to click the submit button once!

Pickup Request Form Provided by American West Worldwide Express, Inc.