PWS_App_I_-_Request_Form_-_Specialized.pdf

DRAFT - SPECIALIZED RATE REQUEST FORM

Contractor's Name: Phone #:

Offer Numbers:

Shipper Site: Shipper Site POC:

Phone #:

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

Pick-Up Date: Delivery Required Date:

Miles: Commodity:

Weight: Dimensions:

Length / Width / Height

Equipment Type: Tarp Required:

Special Requirements:

Carrier 1 - Name * Line Haul Rate:

Contact: Phone #:

Carrier 2 - Name * Line Haul Rate:

Contact: Phone #:

Carrier 3 - Name * Line Haul Rate:

Contact: Phone #:

RATE:

Approved RPM / Minimum Charge

CONTRACTING OFFICER DATE:

Line Haul Rates: Use Rate Per Mile or Minimum Charge as applicable (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