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Date

RAIL CAR RATE REQUEST FORM

SHIPPER INFORMATION (please fill out and send 2 if there are multiple origins)
Shipper Name *
Physical Address *
City / ST / ZIP *
Contact Name *
Contact Phone # *
Email *
Is Shipper Rail Served? *	Yes	No
If Yes, Which Carrier? *
Do they ship Rail today? If not, how long has it been since they have?
RECEIVER INFORMATION (please fill out and send 2 if there are multiple destinations)
Receiver Name*
Physical Address
City / ST / ZIP
Contact Name
Contact Phone #
Email
Is Receiver Rail Served?	Yes	No
If Yes, Which Carrier?
Do they ship Rail today? If not, how long has it been since they have?

BILL TO PARTY? Shipper , Receiver , or Third Party ?
Name
Address
Physical Address
Contact Name
Contact Phone #

PRODUCT INFORMATION
Description: (ie: Canned Goods, Wine, Plywood, Steel Coils, etc.)
7 Digit STCC Code
Product Specifications (if transloading required) Dimensions/Weight

COMPETITIVE INFORMATION
Volume
Who is Moving the Traffic Today?
What is the Current Rate?

RAIL EQUIPMENT
Type (ie: Plain Boxcar, Insulated, Open Gon, Covered Gon, etc)
Size: