CD-579
(12/02) U. S. DEPARTMENT OF COMMERCE
FREIGHT TRANSPORTATION SERVICE ORDER
This government shipment is subject to terms and conditions of 41 CFR 102-117 and 118.
This is to confirm a request for the following transportation and or related transportation services.
1. Date:
2. Organization Reference Number (optional):
3. Bill of Lading No.:
4. Issuing Office:
5. To: TRANSPORTATION SERVICE PROVIDER
Contact Name:
Telephone:
Fax:
Complete Carrier Name, SCAC and Address:
6. Address;
7. City:
8. State:
9. ZIP:
10. POC Name:
11. Phone:
FAX:
12. ACCOUNTING INFORMATION:
Shipment Information
13. From: Origin (Consignor)
14. To: Destination (Consignee)
Organization/Business:
Organization/Business:
Attn (POC):
Attn (POC):
Street Address:
Street Address:
City:
State:
ZIP:
City:
State:
ZIP:
Country:
Country:
Phone:
Fax:
Phone:
Fax:
Email address:
Email address:
15. Date Available for Shipment:
16. Required Delivery Date:
17. Driver Signature: Date:
18. Carrier Way/Freight Bill No.:
Description of Articles to be Shipped
19. PACKAGE 20. WEIGHT
NO. KIND HM Description, Dimensions & Weight of all items to be shipped (use clear, non-technical terms): FOR USE OF BILLING CARRIER ONLY
CLASSIFICATION ITEM NO. (POUNDS ONLY SERVICES Rates Charges