Schedule a Pickup/Delivery
Please check this box if this shipment is a lease return.
contact information
Name: Email: Phone:
delivery details
Pick Up Date:
Delivery Date:
Declared Value:
PO #:
Pickup # of Stairs:
Delivery # of Stairs:
delivery information
pick up location
Company:
Address 1:
Address 2:
City:
State:
Zipcode:
Contact:
Phone:
delivery location
Company:
Address 1:
Address 2:
City:
State:
Zipcode:
Contact:
Phone:
items
QtyProduct #DescriptionSerial #Lease #Weight 
pick-up & return
Pick-Up & Return
Special Instructions
notification
Status Change Notification
Final Delivery Notification
Please add any additional email notifications in the boxes below. Include a comma after each email, if you have multiple recipients. Example: bob@fmd.com, joe@fmd.com, matt@fmd.com