Courier pickup request

Information for the courier

Name*

(this information is so important and could be used for parcel declaration)

Surname*

(this information is so important and could be used for parcel declaration)

E-mail*

(this information is so important and could be used for parcel declaration)

Phone*

(this information is so important and could be used for parcel declaration)

State*

(this information is so important and could be used for parcel declaration)

City*

(this information is so important and could be used for parcel declaration)

Address (first line)*

(this information is so important and could be used for parcel declaration)

Address (second line)*

(this information is so important and could be used for parcel declaration)

ZIP code*

(this information is so important and could be used for parcel declaration)

Information for the courier

Desired date of pickup*

Time

Number of parcels*

Shipment description**

Ship to

Receiver information

Name*

(this information is so important and could be used for parcel declaration)

Surname*

(this information is so important and could be used for parcel declaration)

Phone*

(this information is so important and could be used for parcel declaration)

Country*

(this information is so important and could be used for parcel declaration)

City*

(this information is so important and could be used for parcel declaration)

Address (first line)*

(this information is so important and could be used for parcel declaration)

Address (second line)*

(this information is so important and could be used for parcel declaration)

ZIP code*

(this information is so important and could be used for parcel declaration)

Delivery type*