Shipping Information

Please complete the form below and we will schedule a pickup from your department if necessary. Thank you.

Date:

Name: *

E-mail address:

Telephone Number: *

Department & Room/Office #:

Vendor's Name: *

Shipping Company:

*Fed Ex Express Acct. #:

Reason for return: *

Cost Center #:

Fund #:

Return Authorization #:

Insured Amount: *

Ship To: (as written on shipping labels):

Reference Original P.O. #:

Document #:

Line Item #:

Quantity #:

Contents if not referenced to a Purchase Order: *

Number of Cartons to be picked up: *

For Office Use Only:

(Print) Name of Faculty/Staff:

Name of Central Receiving Driver:

If you happen to see this, do not fill this field.