Dd Form 2784 - Letter Of Intent (Loi) Household Goods Or Unaccompanied Baggage
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1
2LETTER OF INTENT (LOI)
HOUSEHOLD GOODS OR UNACCOMPANIED BAGGAGE
(Prescribed by DTR 4500.9-R)
SECTION I
(For PPSO use only)
1. TITLE
2. SIGNATURE
3. ACCEPTANCE DATE
4. EFFECTIVE
(Cycle)
(YYYYMMDD)
SECTION II
(For Carrier use only)
You are requested to accept this LOI as evidence of our intent to provide personal property services from your area(s) of
responsibility. We are a DoD approved carrier and copies of Federal and/or state certificates and/or permits are on file with HQ SDDC.
I certify that the following statements are true and complete. Any misrepresentation and/or falsification may be subject to prosecution
under Section 1001, Title 18, United States Code. I further certify I have written agreements with agents indicated on this LOI for the
purpose of handling noted codes of service. I certify that facilities of these agents have been inspected by an authorized
representative of my company and such facilities meet the standards of the tender of service.
5. CARRIER APPROVING OFFICIAL
a. TYPED NAME
b. TITLE
c. SIGNATURE
d. DATE
(Last, First, Middle
(YYYYMMDD)
Initial)
NOTE: LOI will remain on file continuously until replaced by another LOI or returned by PPSO.
7. SCAC
6. CARRIER NAME
8. ADDRESS
9. TELEPHONE NUMBER
10. FAX NUMBER
(Street or P.O. Box Number, City, State, ZIP Code)
(Include Area Code)
(Include Area Code)
11. EMAIL ADDRESS
12. OTHER CONTACT
13. TO
(Personal Property Shipping Office/BLOC)
14. TYPE OF LOI
15. NEW OR REPLACEMENT LOI
(X one)
(X one)
DOMESTIC INTRASTATE
INTERNATIONAL HHG
NEW LOI
DOMESTIC INTERSTATE
INTERNATIONAL UB
REPLACES LOI ACCEPTED
(YYYYMMDD)
16. THIS LOI IS APPLICABLE TO OPERATING AREA(S):
(List)
17. SCOPE OF OPERATING AUTHORITY
(As indicated on certificates/permits on file with HQ SDDC) (X as applicable)
CAE = CONUS + AK WITH
C = CONUS
EXCEPTION
(Specify)
CAHE = CONUS + AK & HI
CA = CONUS + AK
WITH EXCEPTION
(Specify)
I = INTRASTATE
CAH = CONUS + AK & HI
(Specify)
CE = CONUS WITH
EXCEPTION
(Specify)
DD FORM 2784, NOV 2008
Reset
PREVIOUS EDITION MAY BE USED.
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