PWS_App_I_-_Request_Form_-_New_Lanes _Revisions _Additions.pdf

DRAFT - PWS APPENDIX I REQUEST FORM

NEW SCHEDULED LANE, RATE REVISION/ADDITION

REQUEST FORM

Contractor's Name: Phone #:

Shipper Site: Shipper Site POC:

Phone #:

Origin City, ST, Zip: Destination City, ST, Zip:

Equipment Type: Miles:

Justification:

Carrier 1 - Name * Line Haul Rates:

Contact: Phone #:

Carrier 2 - Name * Line Haul Rates:

Contact: Phone #:

Carrier 3 - Name * Line Haul Rates:

Contact: Phone #:

Carrier 4 - Name * Line Haul Rates:

Contact: Phone #:

Carrier 5 - Name * Line Haul Rates:

Contact: Phone #:

Carrier 6 - Name * Line Haul Rates:

Contact: Phone #:

RATE:

Approved Rate Per Mile & Minimum Charge

CONTRACTING OFFICER DATE:

List both Rate Per Mile and Minimum Charge (DO NOT use all-inclusive or flat rates).

Contracting Officer's Determination of Reasonableness:

*Spot Quote rates are strictly for LINE HAUL ONLY (excluding any fees, accessorials, fuel, etc.)

APPROVED / DISAPPROVED:

NTE_Request