SOP Domestic Shipping Form

Your Business Name *

Receiver information

Name *

Business Name

Phone Number *

Receiver Email Address

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Shipping Options

Who is paying?

Preferred shipping company?

Preferred shipping method?

Do you have an account with this carrier? If yes, please provide us the account number.

Please provide us the account number.

Additional carrier services available if desired (check all that apply)Insurance (please include the dollar amount in Additional Information)Signature upon deliveryNO ADDITIONAL SERVICES

Additional information (specific serial number, lot number, or other notes regarding this shipment)

Disclosure: If you will be using Dawa Medical's carrier account, you will be charged back for the shipping fees, plus 10% *I have read the disclosure.

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