PACKAGE INFORMATION FORM Please submit the details of your shipment to retrieve the package identification number for your shipment. For each package shipped through your PPO box, you must provide us with 1) The U.S. tracking number provided to you by the seller. This number is required to properly identify and process your package. 2) Details of the Package contents including correct value in $USD 3) Information on the Recipient & delivery address. You can use this number for only one shipment. You must submit a new form for each shipment you plan on sending
*Please check to make sure your items are not on the "Banned Items" list: List of Banned Items. Items on this list will not be shipped internationally by ICC Worldwide and will be detained in the US. ICC will not ship any large liquid items such as cleaners, oils, and other fluids.
Date   :	mm/dd/yyyy
Name*   :
Company Name   :
PPO NUMBER*   :
Email*   :
RECIPIENT NAME & ADDRESS*   :
RECIPIENT PHONE NUMBER*   :
US ORDER TRACKING NO.* (fedex, USP, USPS)   :
Item Type*   :
Description of Contents*   :
Quantity of items in Package*   :
TOTAL Item Value USD*   :
Would you like to insure your package for the item Value? The charges are 3% of the Item Value indicated above. Insurance covers theft and damage from the time we receive your package to delivery.   :	-None- No Yes
Customer Notes   :
Name of Shipper   :
Shipped/Purchase From   :
Approx. Package Weight LBS.   :
Verification Required*   :	I have verified the information above is correct*