Order Tender for Customer Use Δ PLEASE BE SURE TO COMPLETE ALL SECTIONS OR ENTER "N/A" FOR NOT APPLICABLECarrier Tender InformationDate Time Hours : Minutes AM PM AM/PM Company(Required) Name Order No.(Required)Pick Up No.(Required)Bill of Lading No.(Required)SHIPPED FROM COMPANYName(Required)Customer P.O.(Required)Ship To No.(Required) City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Schedule Ship Date Time Hours : Minutes AM PM AM/PM SHIP TOName(Required) City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code MAIL FREIGHT BILLS TOName(Required) City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code TOTAL SHIPPING WEIGHTS:(Required)BILL CHARGES: Prepaid Collect Third Party ITEMH/MEQUIPMENT REQUIREMENTS AT PICKUPTRAILER TYPE: Single Multi-Compartment DISCHARGE LOCATION: Rear Center VAPOR RECOVERY: Yes No Ground Level Vapor: Yes No OFFLOAD: Carrier Customer Provided SPECIAL SHIPPING INSTRUCTIONSTEMP REQUIREMENTS: Yes No STEAM REQUIRED: Yes No TEMPERATURE REQUIREMENTS: Low High HEAT IN TRANSIT: Yes No HEAT EXCHANGE: Yes No PPE LEVELSCheck box for appropriate level PPE from list below: Level 1 Level 2 Level 3 Level 4 Level 5 Check box for appropriate level PPE from list below: Level 1: Hard hat, face shield, goggles, chemical gloves, steel-toe boots, long-sleeve uniform shirt and long pants. Level 2: Hard hat, face shield, goggles, chemical gloves, steel-toe boots, long-sleeve uniform shirt, long pants, reflective vest or long-sleeve reflective FR vest. Level 3: Hard hat, face shield, goggles, chemical gloves, steel-toe boots, long-sleeve FR shirt and pants or FR coverall. Level 4: Hard hat, face shield, goggles, chemical gloves, steel-toe rubber boots, acid safety suit (top and bottom) or Ansell suit. Level 5: Hard hat, face shield, chemical gloves, steel-toe rubber boots, acid safety suit (top and bottom), and full-face respirator with supplied air system. EQUIPMENT REQUIREMENTS AT DELIVERY(hose, fittings, etc.):(Required)SPECIAL DELIVERY INSTRUCTIONSCUSTOMER PUMP or AIR: Yes No CARRIER PUMP or AIR: Yes No PUMP REQUIRED: Yes No Carrier Customer PACKAGE DESCRIPTION:SHIPPING INSTRUCTIONS:PPE LEVELSCheck box for appropriate level PPE from list below: Level 1 Level 2 Level 3 Level 4 Level 5 Check box for appropriate level PPE from list below: Level 1: Hard hat, face shield, goggles, chemical gloves, steel-toe boots, long-sleeve uniform shirt and long pants. Level 2: Hard hat, face shield, goggles, chemical gloves, steel-toe boots, long-sleeve uniform shirt, long pants, reflective vest or long-sleeve reflective FR vest. Level 3: Hard hat, face shield, goggles, chemical gloves, steel-toe boots, long-sleeve FR shirt and pants or FR coverall. Level 4: Hard hat, face shield, goggles, chemical gloves, steel-toe rubber boots, acid safety suit (top and bottom) or Ansell suit. Level 5: Hard hat, face shield, chemical gloves, steel-toe rubber boots, acid safety suit (top and bottom), and full-face respirator with supplied air system.
