Break Bulk Request Form

Contact Information

Name *

Phone *

Email *

Company *

Carrier Information

Carrier *

if other:

Agent

if other:

Vessel or Service

Cargo Direction *

Cargo Information (The dimensions inputted must be consistent with the unit of measure selected) Only include the net weight and dimensions of the cargo itself

Units *

Length *

Width *

Height *

Units *

Weight *

Cargo Description *

Additional Information

Will the cargo be stripped off or secured onto a flat rack container? On Off

Will the cargo be discharged into or loaded out of the water? In Out

Will the cargo be placed to or lifted off the ground? On Off

Is the cargo drivable? Yes No

Will you require storage at the terminal? Yes No

Mode of Transport

Cargo Destination

if other:

How will the cargo have to be stowed? (see the picture below)

Athwartship Stow Fore & Aft Stow

Please attach any files that assist creating your Breakbulk quote (supported .png, .jpg, .docx, .pdf and .xls). Max total 3MB

Photos of Cargo:

Diagrams/Photos of lift points and center of gravity:

Any other important features:

List important distinguishing marks & features and the model and make of Cargo