Order form
Name sender:
Address:
Tel.:
Fax:
E-mail:
Name receiver:
Address:
Tel.:
Fax:
E-mail:
Vehicle information:
Year: Make/model: VIN-number: Colour: Value ($):
 
Information other cargo:
Number: Package: Content:
Value ($): Weight (kg): Sizes (lxwxh, in cm):
Special instructions:  
Port of destination: Passportnr.
or EINnr.:
Insurance: Yes No Insurance
beneficiary:
Sender
Consignee
Policy excess:
Undersigned hereby authorizes Roltrex Cargo Broker to sign and endorse all documents related to that shipment. The above is a correct declaration and if the shipment for any reason be refused or returned, then the undersigned agree to all by him to pay costs. Liability for warehouse and property is limited to $ 500 per vehicle and $ 40 per item, with a limit of $ 500. Insurance can be obtained at the office of Roltrex Cargo Broker prior to export, against additional payment. The undersigned also agrees to all terms and conditions of Roltrex Cargo Broker and the Bill of Lading from the carrier. In addition, the undersigned declares that no hazardous (flammable, explosive, corrosive, etc.) substances are transported. All shipments are delivered prepaid, unless other arrangements are made.
Name:
  • Taal | Language | Sprache

Nederlands

English

Deutsch

  • Contact

Roltrex Cargo Broker BV

Distributieweg 11

2742 RB Waddinxveen

The Netherlands

Tel.: +31-­180-63 47 77

Fax: +31-­180-63 11 99

  • Certification