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*

ImportExport

Single or Recurring (optional)

SingleRecurring

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