CHAMPION LOGISTICS GROUP, INC.

Order #  Phone #

Origin Pickup Location

Name    

Address:  

Phone:      Hours:

Destination Deliver Location

Name    

Address:  

Phone:      Hours:

Commodity: Class:

Hazmat?  Yes    No

Type and Size of Equipment Required:

Weight:    Skids:

:        

Special Instructions:  

Freight Charges Billed to: