City or 5-digit Zip
State
From:
AL
AZ
AR
CA
CO
CT
DE
DC
FL
GA
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
ON
OR
PA
PQ
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
To:
AL
AZ
AR
CA
CO
CT
DE
DC
FL
GA
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
ON
OR
PA
PQ
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Freight Charge
Fuel Surcharge
Total Charge