COMPANY NAME: _____________________________________________________________

STREET ADDRESS: _____________________________________________________________

SUITE/ROOM #: _____________________________________________________________

CITY: _____________________________________________________________

STATE: _____________________________________________________________

ZIP CODE: ______________________ COUNTRY: _____________________________

PHONE #: _________________________________________ EXT. #: _____________

FAX #: _____________________________________________________________

E-MAIL ADDRESS: _____________________________________________________________

COMMODITY: _____________________________________________________________

ORIGIN: _____________________________________________________________

DESTINATION: _____________________________________________________________

Please specify dimension and weight of each piece (including packaging):

_____ @ ________ (L) x ________ (W) x ________ (H) ____________ KILOS / LBS

_____ @ ________ (L) x ________ (W) x ________ (H) ____________ KILOS / LBS

_____ @ ________ (L) x ________ (W) x ________ (H) ____________ KILOS / LBS

_____ @ ________ (L) x ________ (W) x ________ (H) ____________ KILOS / LBS

_____ @ ________ (L) x ________ (W) x ________ (H) ____________ KILOS / LBS

_____ @ ________ (L) x ________ (W) x ________ (H) ____________ KILOS / LBS

_____ @ ________ (L) x ________ (W) x ________ (H) ____________ KILOS / LBS

_____ @ ________ (L) x ________ (W) x ________ (H) ____________ KILOS / LBS

_____ @ ________ (L) x ________ (W) x ________ (H) ____________ KILOS / LBS

_____ @ ________ (L) x ________ (W) x ________ (H) ____________ KILOS / LBS

Please specify mode of transportation:

______ AIR ______ SEA ______ LAND

Special handling / instructions:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

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PLEASE FAX ABOVE INFORMATION TO +1 (516) 616-7676. THANK YOU.