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Type of Pick-up:    Business With Loading Dock Business Without Loading Dock Residential Pickup Inside Pickup

Province/State* AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon TerritoryAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Type of Drop:    Business With Loading Dock Business Without Loading Dock Residential Pickup Inside Pickup

Equipment Type 53' Tandem53' Plate53' Tridem53' Quad53' Tandem Reefer53' Tridem Reefer53' Tandem Heat53' Tridem Heat48' TriaxleFlatbed

Drop Trailer Required:    Yes No

**Declared Value $

Maximum liability of $2.00 per pound unless declared valuation states otherwise.

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