DATE
If no service is selected, the most cost e cient service will be used.
DATE TYPE OF SERVICE: (CIRCLE ONE) 2day Ground
Next Day SENDER:
Sender Name: Address: Dept. Name/Mailstop: Building Name/ Room Number: 4 Digit Account Code or Fund/Accounting Number:
Express Saver
SHIP TO:
Company/Department: Recipient's Name: Address: Suite/Floor City: State : Zip:
SHIPPING REQUEST
State Form 53793 (11-08)
Tracking Number