Request for Brokerage Quotation

All Required Fields (with an asterisk * ) must be completed before this form can be submitted

Name and address *

Email Address *

Telephone (optional)

Approximate Shipping Date (optional)

Date

Import or Export *

Import Export

Single or Recurring (optional)

Single Recurring

If Recurring, approximately how many consignments per month are anticipated? *

Mode of Transportation *

Terms of Delivery *

Web Link to Product Detail (optional)

Commodity Description (Item 1) *

Country of Origin, Manufacture or Growth *

Value (Item 1) *

Currency *

Harmonized System Number (If known)

Additional Items?

Yes

Commodity Description (Item 2) *

Country of Origin, Manufacture or Growth *

Consignment Value (Item 2) *

Currency *

Harmonized System Number (Item 2)

Additional Items?

Yes

Commodity description (Item 3) *

Country of Origin, Manufacture or Growth *

Consignment Value (Item 3) *

Currency *

Harmonized System Number (3)

Additional Items?

Yes

Commodity Description (Item 4) *

Country of Origin, Manufacture or Growth *

Consignment Value (Item 4) *

Currency *

Harmonized System Number (4)

Additional items?

Yes

Commodity Description (Item 5) *

Country of Origin, Manufacture or Growth *

Consignment Value (Item 5) *

Currency *

Harmonized System Number (5)

Note: If more than 5 different Commodities are to be included in the consignment, please contact us on +1 877 432 8484 or email info@canadiancustomshouse.ca