Shipping Request Form
New Shipping Label Needed?
*
Yes
No -- For Internal Documentation Purposes Only
CARRIER PICKUP / FSE DROP OFF
SCHEDULE PICKUP
DROP OFF AT UPS/FEDEX
DAILY PICKUP
Requestor Name:
*
Requestor Email:
*
Requestor Phone:
*
Date:
*
/
Month
/
Day
Year
Date
Department:
*
IMAGING
CLINICAL
ADMINISTRATIVE
JUMP
SERVICE CONTRACT
INTERNAL PARTS
EXTERNAL PARTS
EXTERNAL SALES
SYSTEMS
FROM:
From:
*
Address:
*
Phone Number:
*
TO:
Customer/Site Name:
*
Attention To:
*
Address:
*
Phone Number:
*
BILLING:
Billable:
*
Yes
No
Non-billable:
(Choose None if billable)
*
Contract
Warranty
Postage
None
Customer Name:
PO:
WO#: Enter N/A if Office or Admin related
*
SHIPPING:
All Shipments will be via UPS unless chosen below. If another service is desired, please enter into Detailed Description area at bottom of form
Reason:
*
SATURDAY DELIVERY
FREIGHT, Old Dominion
OVERNIGHT, 1st Priority
OVERNIGHT, Priorirty
OVERNIGHT, Standard
SECOND DAY
THREE DAY
GROUND
OTHER - Put request in Detailed Description
PACKAGE DETAILS
SHIPPING TYPE
STANDARD SHIPMENT
FREIGHT
FEDEX HOLD
Weight:
*
Dimensions:
If "Envelope" just type envelope into Height
Height
*
Length
*
Width
*
Declared Value:
Reason:
*
REPAIR
EXCHANGE
DEFECTIVE
RESTOCK
SALE
OTHER
DETAILED DESCRIPTION
Additionally: If shipping speed or reason are “other,” include that information here. Also include Part Name, Number, and Serial when possible.
*
Would you like a return shipping label included:
*
YES
NO
Tracking Number:
RETURN TRACKING
SHIPPING COST
Shipping Label
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