UPS SHIPMENT REQUEST

Please complete form and fax to 6588 by 12:00 noon to ensure same day shipment. If received after 12:00 noon, request will be processed next business day. Please contact Alecia Oldham at x6657 if you have questions or concerns.

SHIPPER INFORMATION:

NAME

EXT E-MAIL

EXT
E-MAIL

SPECIAL INSTRUCTIONS:

Example: Reference Number; Return Authorization Number;

Charge to Recipient/Third Party – If so, include UPS Account Number

SPECIAL INSTRUCTIONS: Example: Reference Number; Return Authorization Number; Charge to Recipient/Third Party – If so, include UPS Account Number_Row_1
SPECIAL INSTRUCTIONS: Example: Reference Number; Return Authorization Number; Charge to Recipient/Third Party – If so, include UPS Account Number_Row_2
SHIP TO INFORMATION:
COMPANY NAME
ATTENTION
ADDRESS
SUITEDEPARTMENT
CITYSTATE
ZIPPHONE
COMPANY NAME
ATTENTION
ADDRESS
SUITE
DEPARTMENT
CITY
STATE
ZIP
PHONE
SERVICE INFORMATION: CHECK ONE OF THE FOLLOWING
NEXT DAY AIR EARLY A.M. (BY 8:00 A.M.)2ND DAY AIR
NEXT DAY AIR (BY 10:30 A.M.)2ND DAY AIR A.M.
NEXT DAY AIR SAVER (BY 3:00 P.M.)UPS 3 DAY SELECT
GROUND SERVICE
OF
OF
OF
OF
PACKAGING:NUMBER OF PACKAGES:
UPS LETTERPACKAGE 1 WEIGHT
UPS PAKPACKAGE 2 WEIGHT
UPS TUBEPACKAGE 3 WEIGHT
MY PACKAGINGPACKAGE 4 WEIGHT
NUMBER OF PACKAGES:
PACKAGE 1 WEIGHT
PACKAGE 2 WEIGHT
PACKAGE 3 WEIGHT
PACKAGE 4 WEIGHT

INSURANCE REQUIRED:

YES ☐ NO ☐ IF YES, DECLARED VALUE

IF YES, DECLARED VALUE
INSURANCE
REQUIRED:

REFERENCE NUMBER:

PURCHASE ORDER NUMBER
HOW TO GET PACKAGE TO UPS:
DROP OFF AT UPS STOREGIVE TO UPS DRIVER
SCHEDULE PICK-UP**MUST COMPLETE SCHEDULING INFO
SCHEDULING INFORMATION:
PICK-UP DATESHIPMENT READY AT
PICK-UP BYBUILDING
FLOORROOM
TO
TO
PICK-UP DATE
SHIPMENT READY AT
PICK-UP BY
BUILDING
FLOOR
ROOM