Request For Quote.

Company Name
Your Name
Phone xxx-xxx-xxxx
Extension #
Email
State
Zip Code

Shipment Information

Origin City
Origin State	IA IL IN KS KY MO NE OH OK
Origin Zip Code
Destination City
Destination State	IA IL IN KS KY MO NE OH OK
Destination Zip Code
Total Pieces
Total Weight (Pounds)
Dimenions
Accessorial Charges (Check all that apply)	Liftgate Delivery Liftgate Pickup Pallet Jack 2 Person Pickup/Delivery Residential Delivery Residential Pickup Inside Delivery Inside Pickup Military/Government Facility/School Authorize Wait Time Special Pickup/Delivery (limited hours or special availabilty
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
	YesNO
Hazardous Material	YesNO
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