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Use to request transportation support other than airlift support. Reference: FM 701-58.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — UNIT IDENTIFIER _____________________________(Identifier or Unit/Agency Requesting Transportation Support)

LINE 4 — CALL SIGN___________________________________(Call Sign of Unit)

LINE 5 — TELEX_______________________________________(Unit/Agency Telex Number)

LINE 6 — UNIT POC____________________________________(Designated Unit POC)

LINE 7 — RANK/RATE__________________________________(POC Rank or Rate and Rating)

LINE 8 — PRIMARY PHONE_____________________________(Unit POC Primary Telephone Number)

LINE 9 — PRIMARY FREQUENCY________________________(Unit Primary Radio Frequency)

LINE 10 — POC LOCATION______________________________(Unit POC Location Using UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)

LINE 11 — SECONDARY PHONE_________________________(Unit POC Secondary Telephone Number)

LINE 12 — SECONDARY FREQUENCY____________________(Unit Secondary Radio Frequency)

LINE 13 — BILLING ____________________________________(Required Billing Instructions)

LINE 14 — PRIORITY___________________________________(Requestor-Assigned Priority Number)

LINE 15 — MODE______________________________________(Requestor’s Preferred Mode of Transportation)

LINE 16 — PICKUP TIME _______________________________(Desired Pickup DTG for Cargo/Passengers Being Moved)

LINE 17 — ON-LOAD___________________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of On-Load/Pickup Point)

LINE 18 — DELIVERY __________________________________(Desired Delivery Time for Cargo/Passengers Being Moved)

LINE 19 — OFF-LOAD__________________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of Off-Load Point)

LINE 20 — COUNT_____________________________________(Count of Cargo/Passengers to be Transported)

LINE 21 — TYPE_______________________________________(Type of Cargo/Passengers to be Transported)

LINE 22 — LENGTH ____________________________________(Linear, End-to-End Measurement, of Each Type of Equipment)

LINE 23 — WIDTH _____________________________________(Linear, Side-to-Side Measurement, of Each Type of Equipment)

LINE 24 — HEIGHT_____________________________________(Vertical Dimension of Each Type of Equipment)

LINE 25 — WEIGHT ____________________________________(Weight of Each Type of Equipment)

LINE 26 — HAZARDOUS DATA __________________________(Required Hazardous Cargo Data According to Federal Regulation 49 And Joint Service Regulations)

LINE 27 — ADDITIONAL SUPPORT_______________________(Additional Support Requirements at On-Load or Off-Load Points, if Applicable)

LINE 28 — POC FUNCTION _____________________________(Name of the Function of the Mission POC)

LINE 29 — CALL SIGN__________________________________(Call Sign of the Unit to Contact)

LINE 30 — REQUESTING POC ___________________________(Name of the Requesting Unit POC)

LINE 31 — RANK/RATE_________________________________(Rank or Rate and Rating of Requesting POC)

LINE 32 — PRIMARY PHONE ____________________________(Unit POC Primary Telephone Number)

LINE 33 — PRIMARY FREQUENCY _______________________(Primary Radio Frequency of Requesting Unit)

LINE 34 — POC LOCATION _____________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of Reporting Unit POC)

LINE 35 — SECONDARY PHONE_________________________(Requesting POC Secondary Telephone Number)

LINE 36 — SECONDARY FREQUENCY____________________(Secondary Radio Frequency of the Requesting Unit)

**Repeat lines 14 through 36 to initiate multiple requests for transportation support. Assign sequential line numbers to succeeding iterations; for example, first iteration 14 through 36; second iteration 14a through 36a; third iteration 14b through 36b; and so on.

LINE 37 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)

LINE 38 — AUTHENTICATION___________________________(Report Authentication)

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