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# 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 |
| SPECIAL INSTRUCTIONS: |
| Example: Reference Number; Return Authorization Number; |
| Charge to Recipient/Third Party – If so, include UPS Account Number |
|
| SHIP TO INFORMATION: |
| 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 | |
| PACKAGING: | NUMBER OF PACKAGES: |
| UPS LETTER | PACKAGE 1 WEIGHT |
| UPS PAK | PACKAGE 2 WEIGHT |
| UPS TUBE | PACKAGE 3 WEIGHT |
| MY PACKAGING | PACKAGE 4 WEIGHT |
| INSURANCE REQUIRED: |
| YES ☐ | NO ☐ | IF YES, DECLARED VALUE |
| REFERENCE NUMBER: |
| PURCHASE ORDER NUMBER |
| HOW TO GET PACKAGE TO UPS: |
| DROP OFF AT UPS STORE | GIVE TO UPS DRIVER |
| SCHEDULE PICK-UP* | *MUST COMPLETE SCHEDULING INFO |
| SCHEDULING INFORMATION: |
| PICK-UP DATE | SHIPMENT READY AT |
| PICK-UP BY | BUILDING |
| FLOOR | ROOM |