COURIER PICKUP REQUEST

INFORMATION FOR THE COURIER

Name

Surname

E-mail

Phone

State

City

Address (first line)

Address (second line)

ZIP code

INFORMATION FOR THE COURIER

Desired date of pickup

Time

Number of parcels

Shipment description

Ship to

RECEIVER INFORMATION

Name

Surname

Phone

Country

City

Address (first line)

Address (second line)

ZIP code

Delivery type