BTX Salt Lake City Transportation Logistics Solutions
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High Value Products / General Form

* Denotes a required field.

Load Site: *
Load Address: *
City, State, Zip: *
On-site Contact & Phone#: *
Dock Load: Lift Gate Load: # Extra Men Req:
Inside Pickup: Accessible to Tractor Trailer:

Destination Site: *
Destination Address: *
City, State, Zip: *
On-Site Contact & Phone#: *
Dock Delivery: Lift Gate Delivery: # Extra Men Req:
Inside Delivery: Accessible to Tractor Trailer:

Required Load Date: Time:
Delivery Target Date: Time:

Crated Items: Blanket Wrap Items: # Pads Req:

Reference or PO #: Authorized By:

Number of Pieces: Weight:

Pcs xx
Pcs xx
Pcs xx
Pcs xx
Pcs xx
Pcs xx
Pcs xx
Pcs xx
Pcs xx
Pcs xx
Pcs xx
Pcs xx
Pcs xx
Pcs xx
Pcs xx
Pcs xx

Special Instructions: