ACE ELECTRONIC MANIFEST REQUEST FORM

Your Company Name *

SCAC Code *

Submitted By *

PERSON FOR US TO CONTACT FOR MORE INFORMATION

Tel # *

YOUR TELEPHONE

How Would You Like to Receive Your Cover Sheet? *

Fax

Will Call Later

Email Address *

Fax Number *

Arrival Date *

Time 24hr *

USA Port of Arrival *

DO NOT ENTER CANADIAN OR MEXICAN PORTS

Number of Shipments *

ENTER THE TOTAL NUMBER OF SHIPMENTS WITH THIS TRIP

USE THIS FORM FOR ENTRY INTO THE UNITED STATES