ACI e-Manifest Trip Form

U.S. to Canada only

This is the accessible HTML equivalent of the original ACI e-Manifest Trip Form PDF. The original PDF is not tagged for accessibility.

You may fill in this page and print it using your browser’s Print command. There is no online submission, automatic pricing, or storage of your entries. Follow the email/fax instructions below. Fields marked “required in the original form” correspond to its asterisks.

Instructions

Complete the trip form and email it to greenlightservices@gmail.com or submit it by fax for processing.
Wait for the e-Manifest confirmation lead sheet to arrive by email.
The driver must present the e-Manifest lead sheet confirmation to the agent at the Canadian border.

Include invoice documents along with this trip form, if available.
Express filing: $15 additional fee.
Missing, incorrect, or unreadable information may delay processing.
Make multiple copies of this trip form to fax or email each time you cross into Canada.

A. Company / Carrier Information

Company name

Place the PARS label on your printed form, or provide the PARS / SCN number below.

PARS carrier code

Shipping control number Same as PARS barcode number

Contact name

Phone number

Fax number

Email Required in the original form

Expected Canada port of entry

Estimated crossing date MM / DD / YYYY

Estimated crossing time Specify AM or PM below

Crossing time period AM PM

Estimated number of crossings

Crossing frequency Monthly Yearly

B. Shipper Information

Company name and address in the U.S. where goods will be picked up.

Shipper name

Physical street address

City

State / Province

ZIP / Postal code

Country

C. Consignee Information

Destination in Canada of goods being shipped.

Consignees Single consignee Multiple consignees

Consignee name

Physical street address

City

State

ZIP code

D. Cargo Details

Please include any invoices associated with this shipment.

Cargo (commodity) description

Does the shipment contain hazardous materials? Yes No

Total quantity

Unit of measure Cases, crates, boxes, pieces, skids, units, each, etc.

Value ($US / CAN)

Total weight (LBS)

Country of origin

E. Vehicle / Truck & Trailer Information

Other truck type

DOT number If applicable

Transponder ID

Truck license plate number

Truck plate state / province

Truck VIN / Serial number Please print

Trailer information (if applicable)

Other trailer type

Trailer license plate number

Trailer plate state / province