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Company Name:

Name and Surname:

Cellphone:

Fax:

Email:

Address:

Place of Origin:

Place of Delivery:

Commodity:

General

Hazardous

(If hazardous please indicate classification)

Cargo:

Weight:

Dimensions:

Packing Type:

Time of shipment:

If there is any cargo with non- standard dimensions, the length, width, height and weight should be mentioned in remarks.

Other description:

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