Ssrl/lcls User Shipping Request Form printable pdf download

SSRL/LCLS User Shipping Request Form

(Non-Hazardous Material)

Will this be shipped to a location outside of the U.S.? No ___ Yes ___

If yes, user must complete Power of Attorney and certify concurrence with terms and conditions.

Confirm with Cathy Knotts or Lisa Dunn that this has been completed. _______

•

It can take several days to process shipping requests through SLAC. Missing or insufficient information will

delay shipments further.

•

Hazardous Materials Shipments must be declared on the Hazardous Material Shipping Form and must be

approved by ES&H representative.

Your Name: _____________________________ Phone: __________Email: _______________ Date:_______

Proposal #: ________ Spokesperson/PI: _______________________________________________________

Ship to (If being shipped to an intermediary, list all recipients):

Recipient Name:

_________________________________________________________________________

Institution:

_________________________________________________________________________

Address:

_________________________________________________________________________

City:

____________________________ State/Province: ________________________________

Zip:

___________________________ Country: _____________________________________

Intermediary Name: ________________________ Address:_______________________Phone:______________

Ship via:

[ ] Truck

[ ] Federal Express

[ ] UPS

[ ] Consolidated

[ ] Overnight

[ ] Next-Day Air

[ ] ABF

[ ] Economy (2-day)

[ ] Regular Air (3 days)

[ ] Viking

[ ] Ground (5-6 wkg days)

[ ] Airborne Express

[ ] Other: ____________________

Method of payment:

[ ] Pre-paid

[ ] Carrier account: _______________________________

[ ] SSRL/LCLS User Account Number: _______________

Shipment must arrive by: __________________

(this is the date SLAC Shipping & Receiving

looks at to determine shipping method)

Insurance: [ ] none

[ ] declare $_______________

(Declared value is a requirement for

International shipments)

Revised 1/25/2011

Ssrl/lcls User Shipping Request Form

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