Last Received Shipper Name: GBL Number:

Pre-Registration Form

Date/Time:	03/11/2010 01:31:00 PST
Origin Agent:
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GBL #:
Shipper Last Name:	F.I.     M.I.
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Branch (Select One):	A F N M C
Code (Select One):	1 2 3 4 5 6 7 8 J T
Residence Pick Up City:		Origin Rate Area:	Select ... AL AR AZ CA-N CA-S CO CT DE DC FL-N FL-S GA ID IL IN IA KS KY LA MA MI MN MS MD ME MO MT NC ND NE NV NH NJ NM NY OH OK OR PA RI SC SD TN TX-N TX-S UT VA VT WA WI WV WY Alaska-SE-US803 Alaska-KOD-US805 Alaska-ANC-US810 Alaska-FAI-US819 Australia-AS11 Australia-AS21 Belgium Germany Guam Crete Hawaii Iceland Italy Sicily Sardinia Japan-N Japan-C Japan-S Okinawa Korea Netherlands Panama Portugal Puerto Rico Spain Turkey England
Pick Up Date:	Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC         Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31         Year 2005 2006 2007 2008 2009
RDD:	Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC         Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31         Year 2005 2006 2007 2008 2009
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Dest. City/Base(Block 18):		Dest. Rate Area:	Select ... AL AR AZ CA-N CA-S CO CT DE DC FL-N FL-S GA ID IL IN IA KS KY LA MA MI MN MS MD ME MO MT NC ND NE NV NH NJ NM NY OH OK OR PA RI SC SD TN TX-N TX-S UT VA VT WA WI WV WY Alaska-SE-US803 Alaska-KOD-US805 Alaska-ANC-US810 Alaska-FAI-US819 Australia-AS11 Australia-AS21 Belgium Germany Guam Crete Hawaii Iceland Italy Sicily Sardinia Japan-N Japan-C Japan-S Okinawa Korea Netherlands Panama Portugal Puerto Rico Spain Turkey England
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