Shipping Request Form
Department
Department Contact Name
Building/Rm # Contact Phone #
Account # Contact Email
Charge Client Charge #
Vendor Information
Choose One Recipient (shipping a package to) Sender (receiving a package from)
Contact Name Contact Phone #
Company
Street Address Suite/Apt/Room
City/Town/Locality State/Province
Zip/Postal Code Country
Package Information
Deliver By Date Time
Delivery Carrier No Preference UPS FedEx
Insurance Yes No If Yes, declared value
Signature Required Yes No
Equipment Repair Yes No If yes, does department need a return shipping label. Yes No
Special Requirements Dry Ice Freezer Fridge Room Temperature
Client Yes
No If yes, Name/Chart # /
Quantity Unit Type Tracking # (if known) Weight (lbs)
Quantity Unit Type Tracking # (if known) Weight (lbs)
Comments
Received by Date Time AM / PM Total Cost
FOR SATURDAY
DELIVERY
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