____Personal
____Business
Ship Date___________________________
To______________________________________
Sender_____________________________
Company_________________________________
Phone#_____________________________
Address__________________________________
Box #______________________________
________________________________________
(You must have street address – P.O. Box is not acceptable)
City___________________________________________
State/Province_____________________________
Country________________ Postal Code____________
Phone___________________________________
PAYMENT
____Bill 3rd party UPS Acct# _______________
____Bill Shipper
____Bill Receiver UPS Acct# _______________
SERVICES
____Worldwide Express
(Delv 1 – 2 days)
____Worldwide Expedited
____Standard to Canada
(Delv 3 – 5 days)
TYPE OF PACKAGING
WEIGHT & DIMENSIONS
____Envelope
________________________
____Tube ____Box
SPECIAL DELIVERY AND HANDLING
____Deliver Saturday ($10)
____Hold at UPS location
(only available for Worldwide Express Packages)
Excess Insurance Coverage
________Declared Value (No charge for first $100 of insurance, $.35 per $100, thereafter)
UPS CHARGES
Comments: (Package contents)
Base Rate
____________________
Fuel Surcharge (.75% x base rate) + ____________________
Residential Chg ($1.50, if app)
+ ____________________
Package Pickup ($.25 )
+ ____________________
Excess Insurance Coverage
+ ____________________
Special Delivery & Handling
+ ____________________
TOTAL ____________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
Processed by:_________________ Date:___________
ADS 08/02