Request Form

Shipment Details

Company Name: SCAC Code:
Arrival Date: Arrival Time:
United States Port of Arrival: Total Number of Shipments with This Trip:
Send Cover Sheet To: Shipment Release Type (Check One):
PAPS 7523
SECTION 321 3299
Shipment Control Number (Use PAPS Barecode Number):

Shipper Information

Shipper Name:
Street: City:
Province: Postal Code:

Consignee Information

Consignee Name:
Street: City:
State: Zip Code:

Cargo Description

Cargo Description: Quantity:
Unit of Measure (Pieces, Units, Boxes, Skids, etc.): Country of Origin (Optional for PAPS and 3299 Release):
Weight (Indicate lbs or kgs): Value (Optional for PAPS):
Check Here if this Shipment is in Bond: Check Here if this Shipment Contains Hazardous Materials:
Check Here if this Shipment Contains Food: Check Here if this Shipment Contains Food and is Prefiled:

Truck Information

Truck Plate Number with State or Province: Truck VIN Number:
Truck Type: Dot Number (Optional):

Trailer Information

Trailer License Plate Number with State or Province: Trailer Type:
Second Trailer License Plate Number with State or Province: Second Trailer Type:

Driver Information

Driver Name: Cell or Contact Number:
Hazmat: Yes      No Date of Birth:
Citizenship: Gender:
US Address Only: Driver License Number with State or Province:
Fast ID or Passport Number with Country:

Crew/Passenger Information

Crew/Passenger Name: Date of Birth:
Citizenship: Gender:
US Address Only: Driver License Number with State or Province (Optional):
Fast ID or Passport Number with Country:

2nd Crew/Passenger Information

Crew/Passenger Name: Date of Birth:
Citizenship: Gender:
US Address Only: Driver License Number with State or Province (Optional):
Fast ID or Passport Number with Country: