Shipment Detail Checklist - PTS Diagnostics

Company Name *

Email Address *

Order Number *

1. Indicate the shipping account to be billed. Please check appropriate box. *

Shipper
Distributor

Shipper:
• If pre-paid, estimated quote will be provided and must be paid prior to shipment
• Estimated Freight Quote will be provided from a single carrier
• PTS Diagnostics reserves the right to choose carrier and must insure products in accordance with below table.
• Shipments are FCA Origin (Whitestown, IN) or EXW Origin (Whitestown, IN)

Please see the Declared Value Criteria (Insurance) for International Shipments
Shipping on PTS Diagnostics’ Account
Sales Order Value <$1000.00 - No insurance
Sales Order Value >$1000.00 - Insure at full value

Distributor:
Shipments are FCA Origin (Whitestown, IN) or EXW Origin (Whitestown, IN)

Enter N/A for the distributor fields IF one selects Shipper.

Please provide Carrier Name *

Please provide Carrier Phone Number *

Please provide Carrier Account Number *

Is the order/shipment(s) to be Insured? *

Yes
No

(Selecting No indicates shipments(s) for this order will not be insured and no Declared Value will be entered.)

If Yes, please provide the Declared Value (Insurance) to enter for the shipment(s):

Declared Value (Insurance) *

2. Requested Delivery Date *

3. How would you like your order shipped? Please check appropriate box. *

Palletized
Loose boxes

4. Do you require a shipping method for a product which differs from the standard PTS shipment method; i.e. you require products to ship cold-chain? Please note: Prearranged refrigerated truck required for the delivery at the destination. (Additional costs for this option if Yes is checked.) *

Yes
No

If yes, please provide the shipping method you require for your order below:

Shipping Method Required *

5. If there is a backorder, how would you like to proceed? *

Partial Shipment will be accepted
Wait and ship complete

6. All shipments will include the following: Commercial / Proforma Invoice, SED for orders greater than $2500.00, and a Packing slip *

7. Is documentation required to be stamped or apostilled/legalized/attested? *

Yes
No

If yes, please indicate which documents and the address to ship the documents below:

7. Documentation and Address *

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