Dept Name: Date: Pick One:

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Dept Name:
GEOLOGY DEPT.
3006
Date:
INTERNATIONAL
SHIPPING REQUEST
Pick One:
FEDEX
UPS
Pick One:
Express (usually 3-7 business days)
Other – Specify:
DHL
Saver (usually 15-30 business days)
These are estimated times. Delays in customs may occur.
Duties & Fees Charged to:
Sender
Dry Ice – lbs:
HazMat:
Receiver
Class:
Description of contents: (required)
(must have papers attached)
If you are (1) shipping items outside the US to conduct
research or (2) sending specimens outside the US, have you
contacted the Compliance Attorney to discuss export?
Yes
No
NA
Value for Insurance & Custom Purposes (NTE 50K):
E-mail tracking number to:
(automatically insured to $100.00) $
Address: 35 characters only per line including spaces (print please)
Collect Shipping Number
Company
________________
Attention
Address 1
Address 2
City
State
Country
Postal Code
Telephone
Required –
Receivers # only
Signature:
Shipper’s signature below certifies, under penalties of up
to $55,000 per violation prescribed by 49CFR 107.329,
that there are no DOT-regulated materials in the package
unless indicated above.
Printed Name:
Phone:
PLEASE FILL IN COMPLETELY OR PACKAGE CANNOT BE PICKED UP OR SHIPPED
Old forms will not be accepted after July 1, 2014
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