QUOTE

Use this form to submit an online quotation request.
* Required

Customer Details

Existing Customer? *

Yes No

Customer Number

Company Name (Entity) *

Contact Name *

Contact Number *

Email Address *

Customer Details

Collection & Delivery

Type of load *

Load Description

Street Address (a) *

Province (a) *

Street Address (b) *

Province (b) *

Insurance Requirements *
Indicate if insurance is required

I/We require our goods to be insured I/we do not require Insurance, I/we have my/our own

Declaration*
I hereby acknowledge that I (in my personal capacity or as an authorised representative of the above Entity) accept that all loads contracted to Lebrock Logistics are subject to their Standard Trading Conditions.

I Accept

REQUEST A QUOTE

We thank you for your interest in our company and a representative will contact you within 24 hours to help you with your request.

SUBMIT A CLAIM

If you need to submit a claim please complete the form in its enterity and submit it to us.

CREDIT APPLICATION

Download our credit application and email it or fax it back to us.