Government, Machinery and Dimensional Shipments

Dimensional Shipment Clearance and Rate Request Form

Contact Information

Requestor name:
Company name:
Phone Number:
E-Mail:
Fax Number:

Shipment Information

Commodity to be Shipped:
STCC Code:
Is this shipment hazardous or radioactive?	Yes No
Height: (in feet and inches) ( See height and width diagram >>)	H1 H2 H3 H4 H5 H6
Width: (in feet and inches)	W1 W2 W3 W4 W5 W6
Overall length of shipment:
Base length of shipment:
Center of Gravity:
Vertical:
Horizontal:
Net Weight:	(lbs)
Preferred Car type: (if known)	Axles Length C of G Tare weight Deck height
Estimated Value of Shipment:
Are you requesting a rate with full Carmack liability?	Yes No (If no, please sign and return a limitation of Carmack liability form.)
Estimated Volume: (approx. number of railcars)
Shipper:
Origin:
Destination:
Address for unload site: (Note: Shipper shall obtain permission from local Trainmaster to use the track and receive confirmation from the local Track Supervisor that the track can handle the proposed dimensional load. Communicate the exact nature of the load dimensions, weight, equipment requirements and logistics, when requesting permission to use a track. Contact NS Centralized Yard Operations at 800-898- 4296 to reach local personnel.)
Track Owners:
Do you or your customer own the track?	Yes No
If yes, do you have a current side track agreement on file?	Yes No (Contact Nanci Scott, Industrial Development, for assistance (404) 962-5730)
If no, obtain written permission to use the track from the track owner or contact NS Marketing to use a suitable unloading track. NS Marketing will provide a Temporary Siding Lease - Hi Wide loads agreement to sign once the load is cleared.
Do you or your rigger have a current Certificate of Insurance on file with NS Risk Management?	Yes No (Contact Scott Dickerson, Risk Management, for assistance (757) 629-2364
Have you performed a site visit to verify suitability of track for transload?	Yes No
Is the site suitable for your equipment to enter, transload and exit the site with the load?	Yes No
Will the DOT approve permits for you to move the load from the track to the final site?	Yes No
Consignee:
Potential Load Date:	(MM/DD/YY)
Preferred Waybill Route: (if known)
Who is the delivering carrier?:
Current Rate Authority: (if known)
Are you registered with AccessNS?	Yes No (If no, all faxed Bills of Lading incur a $50 charge)
Do you have credit with Norfolk Southern?	Yes No (If no, please download, complete and return a credit application.)
Are you conversant with AAR Open Top Loading Rules?	Yes No
What is you experience level for shipping by rail?:	Experienced - Load and ship more than 10 railcars per year Moderate - Load and ship at least 5 railcars per year New to Rail - Load and ship less than 5 railcars per year, or have never loaded a railcar
Will you be loading the railcar yourself or will you be using an outside contractor/rigger?	Self Contractor
If using a contractor, please provide their name and contact information:
Is your rigger conversant with AAR Open Top Loading Rules?	Yes No Not applicable (self-loading)