Cross-border Load Confirmation Sheet

Carrier Information
Carrier Name:
Contact Name:
Contact Phone:
Carrier Address:
Shipper Information
Shipper Name:
Contact Name:
Contact Phone:
Shipper Address:
Consignee Information
Consignee Name:
Contact Name:
Contact Phone:
Consignee Address:
Load Details
Load Reference # Date
Origin Destination
Commodity Weight
Trailer/Container # Seal #
Border Crossing Location Customs Broker
Additional Instructions / Comments
Shipper Signature
Date
Carrier Signature
Date
Consignee Signature
Date