FORM– EL-TRANS

FORWARDING ASSIGNMENT FORM

You may place an order for transport services by submitting the following form. The mandatory form fields are marked in green. In case of any doubts please contact us – our employees will be happy to assist you with exhaustive information.

ORDERING PARTY

Company name:

Tax:

City:

Zip:

Street address:

Phone:

Fax:

Email:

Contact person:

CONTRACTOR

P.H.U El-trans, Elżbieta Sierocka
ul. Weteranów 100, 05-250 Radzymin
tel. +48 22 786 70 61, fax: +48 22 786 62 01
e-mail: biuro@el-trans.com

LOADING DATE AND PLACE

Date:

Day:

Month:

Year:

Hour:

Leading ID:

Company name:

Phone:

Fax:

UNLOADING DATE AND PLACE

Date:

Day:

Month:

Year:

Hour:

Leading ID:

Company name:

Phone:

Fax:

CARGO

Product:

Weight in Kg:

Liters:

UN number:

ADR class:

Packing group:

Excise product:

Other:

ADDITIONAL REQUIREMENTS CONCEMING LOADING/UNLOADING

Pump:

Compressor:

Adapters:

OTHER

Custom clearance:

Payment form:

Other:

Send a copy to myself.

I authorize the EL-TRANS company to process my data for marketing purposes.