CARRIERS
CARRIERS
RESOURCES
DENSITY CALCULATOR
TRUCKLOAD QUOTE
DEPARTMENT OF ENERGY
FORMS
BILL OF LADING
CREDIT APPLICATION
VENDOR ACH
FUEL SURCHARGE CHART LTL
FUEL SURCHARGE TRUCKLOAD CHART
GLOSSARY
TOOLS
TRANSPORTATION MODES
LIGHTHOUSE (TMS)
LIGHTHOUSE
FEATURES
PRICING
FAQs
ABOUT
ABOUT US
KELLEY FAQs
CONTACT US
CAREERS
888.535.5392
Truckload Request Form
Account Type
*
-- Select Account Type --
Shipper
Consignee
Third Party Prepaid
Third Party Collect
Client Information
Client Name
*
Client Contact
*
Client Phone
*
Client Extension
Client Email
*
Shipper
Zip Code
*
Zipcode of 5 characters must be Numeric.
Zipcode of 6 characters must be Numeric and Characters alternatively.
Shipping Hours
HH
01
02
03
04
05
06
07
08
09
10
11
12
:
MM
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
AM
PM
Time input must have both hours and minutes set.
to
HH
01
02
03
04
05
06
07
08
09
10
11
12
:
MM
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
AM
PM
Time input must have both hours and minutes set.
Consignee
Zip Code
*
Zipcode of 5 characters must be Numeric.
Zipcode of 6 characters must be Numeric and Characters alternatively.
Recieving Hours
HH
01
02
03
04
05
06
07
08
09
10
11
12
:
MM
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
AM
PM
Time input must have both hours and minutes set.
to
HH
01
02
03
04
05
06
07
08
09
10
11
12
:
MM
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
AM
PM
Time input must have both hours and minutes set.
Address Book
Bill To
Company Name
*
Address
*
City
*
State/Province
*
-- Select a State/Province --
AL - Alabama
AK - Alaska
AZ - Arizona
AR - Arkansas
CA - California
CO - Colorado
CT - Connecticut
DE - Delaware
DC - District of Columbia
FL - Florida
GA - Georgia
HI - Hawaii
ID - Idaho
IL - Illinois
IN - Indiana
IA - Iowa
KS - Kansas
KY - Kentucky
LA - Louisiana
ME - Maine
MD - Maryland
MA - Massachusetts
MI - Michigan
MN - Minnesota
MS - Mississippi
MO - Missouri
MT - Montana
NE - Nebraska
NV - Nevada
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NY - New York
NC - North Carolina
ND - North Dakota
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
PR - Puerto Rico
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VT - Vermont
VA - Virginia
WA - Washington
WV - West Virginia
WI - Wisconsin
WY - Wyoming
AB - Alberta
BC - British Columbia
MB - Manitoba
NB - New Brunswick
NL - Newfoundland and Labrador
NT - Northwest Territories
NS - Nova Scotia
NU - Nunavut
ON - Ontario
PE - Prince Edward Island
QC - Quebec
SK - Saskatchewan
YT - Yukon
Zip Code
*
Zipcode of 5 characters must be Numeric.
Zipcode of 6 characters must be Numeric and Characters alternatively.
Stop Offs
Are there any stop offs in route to final consignee?
Stop Off Zip Code
*
Zipcode of 5 characters must be Numeric.
Zipcode of 6 characters must be Numeric and Characters alternatively.
Stop Off Zip Code #2
Zipcode of 5 characters must be Numeric.
Zipcode of 6 characters must be Numeric and Characters alternatively.
Expected Ship Date
*
Expected Delivery Date
*
Appointment Required?
Shipment Details
Total Pallets
*
Total Weight (lbs.)
*
Product Description
*
(20 character max)
Hazardous
Poison
Food
UN ID Number
*
Hazmat Guide
i.e. UN1092
Packaging Group
*
Class Type
*
Class Guide
-- Select a Class --
Class 1
Class 2
Class 3
Class 4
Class 5
Class 6
Class 7
Class 8
Class 9
Equipment Needed
*
Dry Van
Flat Bed
Reefer
Heated
Specialized
Length (inches)
*
Width (inches)
*
Height (inches)
*
RGN
Tarps
Straps
Comments/Special Instructions
(2000 character max)
Request Quote
