Name:*

Title:*

Company:*

Address:*

City:*

State:*

AB AL AR AZ BC CA CO CT DE FL GA IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT NB NC ND NE NH NJ NM NV NY OH OK ON OR PA PQ RI SC SD SK TN TX UT VA VT WA WI WV WY

Zip Code:*

Country:*

Phone:*

Email:

Web Site:

Fax:

How did you find out about us?

Type of Warehousing:

Contract Warehousing
Public Warehousing

What Jacobson Warehouse location are you interested in?

See Warehouse Map

Services:

Merchandise Storage
Order Fulfillment
Reverse Logistics

Is product bar-coded?

Yes No

Average number of SKUs

Average inbound size

Average # of inbounds per month

How will product be received?

Pallet Case

If palletized ...

How many pallets will be received per month?

Pallet weight in pounds

Pallet size in inches (LxWxH)

If cases ...

How many cases will be received per month?

Case weight in pounds

Case size in inches (LxWxH)

Inbound receipts are (check all that apply):

Full TL
Partial TL
Railcar
Other

Product Description

Are products hazardous?

Yes No

If hazardous ...*

Hazardous class*

N/A Class 1: Explosives Class 2: Gases Class 3: Flammable/Combustible Liquids Class 4: Flammable Solids Class 5: Oxidizers Class 6: Poisons Class 7: Radioactive Materials Class 8: Misc.

Do you have MSDS sheets to send us?*

Yes No

Pallets/Product can be stacked ...

One high Two high Three high Four high Five high Six high Can be placed in racking

Average monthly pallet inventory for Hazardous Materials

Average monthly pallet inventory for General Commodities

Average monthly pallet inventory

Average monthly inventory per SKU

Average number of SKU's that will take up the most space

Inventory turns per year

Pick priority:*

Unit Pack Pallet FIFO Lot Number Batch Code Serial Number Other

Outbound orders shipped as ...*

Pack Out Unit Out Both

Average units per order:

Average lines shipped per order:

Orders processed monthly:

Pallets shipped per month:

Cases shipped per month:

Shipment Profile:

TL LTL Case Pick

Value of product:

per Case Unit

Orders received by:

Phone Fax Email

Is Jacobson Logistics to provide transportation?

Yes No

If yes, origins and destinations:

Required hours of coverage:

Additional information and special requirements: