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CONTENT="Windsor,Windsor Distribution,Distribution,Trucking,Pool Distribution">
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<title>Windsor Distrinbution Pickup Request</title>
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<p align="center"><b><i><font SIZE="+2">PICKUP REQUEST</font></i></b></p>
<p align="center"><strong>Please provide the following information so that we may complete
your pickup request.</strong></p>
<form method="POST" action="_vti_bin/shtml.dll/pickup.html" webbot-action="--WEBBOT-SELF--">
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<tr>
<td width="100%" colspan="2"><div align="center"><center><p><strong>PICKUP LOCATION:</strong>
</td>
</tr>
<tr align="center">
<td width="50%"><strong>CONSIGNEE:</strong></td>
<td width="50%"><input NAME="CONNAME" TYPE="text" SIZE="35" tabindex="1"></td>
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<tr align="center">
<td width="50%"><strong> ADDRESS1:</strong></td>
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<td width="50%"><strong>ADDRESS2:</strong></td>
<td width="50%"><input NAME="CONADD2" TYPE="text" SIZE="35" tabindex="3"></td>
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<tr align="center">
<td width="50%"><strong>CITY:</strong></td>
<td width="50%"><input NAME="CONCITY" TYPE="text" SIZE="25" tabindex="4"></td>
</tr>
<tr align="center">
<td width="50%"><strong>STATE:</strong> </td>
<td width="50%"><select name="CONSTAT" size="1" tabindex="5">
<option value="Delaware">Delaware</option>
<option value="Maryland">Maryland</option>
<option value="New Jersey">New Jersey</option>
<option value="New York">New York</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Virginia">Virginia</option>
<option value="Washington ">Washington</option>
</select></td>
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<tr align="center">
<td width="50%"><strong> ZIP:</strong></td>
<td width="50%"><input NAME="CONZIP" TYPE="text" SIZE="6" tabindex="6"></td>
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<tr align="center">
<td width="50%"><strong>CONTACT NAME:</strong></td>
<td width="50%"><input NAME="CONCON" TYPE="text" SIZE="25" tabindex="7"></td>
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<tr align="center">
<td width="50%"><strong>CONTACT NUMBER:</strong> </td>
<td width="50%"><input NAME="CONNUM" TYPE="text" SIZE="25" tabindex="8"></td>
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<tr align="center">
<td COLSPAN="2" HEIGHT="20"><div align="center"><div align="center"><center><table
width="100%" border="1">
<tr>
<td align="middle" width="82%" colSpan="4"><strong>PICKUP INFORMATION</strong></td>
</tr>
<tr>
<td align="middle" width="82%" colSpan="4"><strong>RGA NUMBER: <input tabIndex="9"
size="15" name="RGA"></strong></td>
</tr>
<tr>
<td align="middle" width="4%"><div align="center"><center><p><strong>PCS</strong> </td>
<td align="center" width="1%"><strong>HAZ</strong></td>
<td align="center" width="64%"><div align="center"><center><p><strong>DESCRIPTION OF
PRODUCTS</strong> </td>
<td align="center" width="13%"><strong>WEIGHT</strong></td>
</tr>
<tr align="center">
<td align="middle" width="4%"><input size="5" name="PCS1"></td>
<td align="middle" width="1%"><input style="FONT-SIZE: xx-large" type="checkbox"
value="ON" name="HAZ1"></td>
<td align="middle" width="64%"><textarea name="DES1" rows="1" cols="40"></textarea></td>
<td align="middle" width="13%"><input size="5" name="WGT1"></td>
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<td align="middle" width="4%"><input size="5" name="PCS2"></td>
<td align="middle" width="1%"><input style="FONT-SIZE: xx-large" type="checkbox"
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<td align="middle" width="64%"><textarea name="DES2" rows="1" cols="40"></textarea></td>
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<td width="1%"> </td>
<td width="64%"> </td>
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<tr>
<td width="563" colSpan="2" height="19"><div align="center"><center><p> <b>SHIPPER
INFORMATION:</b> </td>
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<tr align="center">
<td align="middle" width="50" height="19"><input style="FONT-SIZE: xx-large"
type="checkbox" value="ON" name="NOTPRO"></td>
<td align="left" width="509" height="19">Please notify me if product not available for
pickup</td>
</tr>
<tr align="center">
<td align="middle" width="50" height="19"><input style="FONT-SIZE: xx-large"
type="checkbox" value="ON" name="NOTCOM"></td>
<td align="left" width="509" height="19">Please notify me when pickup is completed.</td>
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<tr align="center">
<td width="50" height="23"><div align="center"><center><p>Email: </td>
<td vAlign="center" align="center" width="509" height="23"><input size="35" name="EMAIL"></td>
</tr>
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</center></div><div align="center"><center><p><b>OTHER COMMENTS:</b></p>
</center></div></div></td>
</tr>
<tr ALIGN="center">
<td COLSPAN="2"><div align="center"><center><p> <textarea NAME="COMMENTS" ROWS="5"
COLS="47"></textarea></td>
</tr>
<tr ALIGN="center">
<td COLSPAN="2"><input type="submit" value="Submit" name="B1"><input type="reset"
value="Reset" name="B2"></td>
</tr>
</table>
<div align="center"><center><p> </p>
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<p align="center"> </p>
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