QRX - Rate Request












	QRX Head Office Curzon Street Tennyson Q 4105 (PO Box 262 Archerfield Q 4108) Ph: +61 7 3892 8111 Fax: +61 7 3892 8140 ACN: 009 683 452 Email: qrx@toll.com.au

Please fill out the form below and submit your request. Your request will be returned to you within 48 hours. Should you have any specific requests please contact our customer service line on 132 482.

CUSTOMER RATE REQUEST * indicates mandatory fields
Contact Information
*Name:
*Company:
Position:
*Address:
*City:
State:	*Post Code:
* Phone Number:
*Email Address:
Fax:
Freight Description
*Freight Type:	Dry Refrigeration
*Profile of Freight: (if more than one type, select accordingly)	Bulk Pallets Containers	Skids Cartons Bulk Bag
	Other:
*Dangerous Goods:	Yes No If yes, Class:
*Long Freight:	Yes No
Product Description:
*Weight:	Kg
Freight Measurements:
*Length:
*Width:
*Height:
Origin:
*Address:
*City:
State:	*Post Code:
Desintation:
*Address:
*City:
State:	*Post Code:
Comments:
Pickup:
Day:	Time:
Average weight per pickup:
No. Pickups per week:
No. Deliveries per week:
Estimated Tonnes per year:
QRX Account Manager (if known):
Please contact me by:	Email Phone Mail
Thank You...

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