Request For Quote.

Company Name    
Your Name    
Extension #
Zip Code    

Shipment Information

Origin City    
Origin State    
Origin Zip Code    
Destination City    
Destination State    
Destination Zip Code    
Total Pieces    
Total Weight
Accessorial Charges
(Check all that apply)

No Convention Center pickups or deliveries. Contact your local cartage agent!
C.O.D. $
Excess Value $
C.O.D. $
Contact Midwest Express Co. if over $50,000.00
Hazardous Material    
Hazmat Class
Midwest Express will NOT Accept the Following Hazmat:
  Division 1.1 - 1.2 - 1.3 - 1.4 - 1.5 - 1.6
  Division 2.3, Hazard Zone A
  Division 6.1, PG1, Hazard Zone A
Highway Route Controlled quantities of a Class 7 as defined in 49 CFR 173.403
Note / Comments