UPS Shipment Request

Date:

Package From:

• Name:
• Department:
• Pro Card #:
• Expiration Date:
• Phone Ext:
• Signature:

Package To:

Do not attempted to ship to a PO Box; a street address is required

• Type of Service: Ground
• # of packages to this address:
• Type of Delivery: Commercial
• Requires package phone number:
• Requires package description:
• Select Optional Services (Additional Insurance at .35 per $100)
• Amount over $100:

A copy of this form will be returned to you with your receipt attached

SHIPPING/RECEIVING USE ONLY

• Date Received by:
• Shipping/Receiving:
• CHARGES:
• Date picked up by UPS:
• Shipping Charges:
• Weight:
• Extra Insurance:
• Zone:
• Total Charges:

Print this page, then complete the requested information above and give it to the mailroom.