SHIP FROM INFORMATION

DEPARTMENT NAME    DATE 

ETSU INDEX NUMBER     cHART (e or F)    

CONTACT NAME      PHONE 

SHIPPING METHOD

  UPS OVERNIGHT    UPS 2nd DAY     UPS GROUND (3 TO 5 DAY) 

  OTHER 

IF INSURING FOR MORE THAN $100.00, PLEASE SPECIFY THE AMOUNT HERE: $

if you would like to be notified by e-mail when your package ships & the tracking number from UPS, 

Please enter your e-mail address

SHIP TO INFORMATION

                                   BUSINESS ADDRESS    or    RESIDENTIAL ADDRESS  (Please check one)

COMPANY NAME 

CONTACT NAME  

PHONE NUMBER    

ADDRESS 1 

ADDRESS 2 

ADDRESS 3 

CITY          STATE             ZIP