Rates Form "*" indicates required fields Agent Owner First Name* Agent Owner Last Name* Agent #* Agent Phone #* Agent Email* Customer Name* Customer #* New Rate/Tariff Effective Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Does the Rate/Tariff have an Expiration Date?* Yes No Expiration Date of Rate/Tariff* MM slash DD slash YYYY Single Lane* Yes No Origin* Destination* Miles of Lane, if applicable*Monthly Load Volume* Minimum Weight (if applicable)*Maximum Weight (if applicable)*Please attach a list on lanes being recorded and attach a spreadsheet with the list of information. The information should include origin, destination, miles of lines if applicable, monthly load volume, and min/max weight if applicable. Attach file described above Drop files here or Select files Accepted file types: pdf, ppt, pptx, doc, docx, Max. file size: 5 MB, Max. files: 10. Is this a short term project that is under a year? Yes No Are the Rates:All in (includes fuel)Linehaul onlyIs there an updated accessorial schedule? Yes No Please attach updated accessorial schedule here Drop files here or Select files Accepted file types: pdf, ppt, pptx, doc, docx, Max. file size: 5 MB, Max. files: 10. Do any of the accessorials apply to this lane/s? Please attach customer's approval here:* Drop files here or Select files Accepted file types: pdf, ppt, pptx, doc, docx, Max. file size: 5 MB, Max. files: 10. Please add any applicable notes:CAPTCHA
