Logistical Services

SPECIAL DELIVERY REQUEST FORM

IF ANY CHARGES APPLY FOR THIS REQUESTED SERVICE, YOU WILL BE NOTIFIED IN ADVANCE.

Any questions‚ please call (973) 972–4573 for Northern Campuses

or (856) 566-6027 for Central and Southern Campuses

PLEASE COMPLETE ALL AREAS AND SUBMIT FORM BELOW.

Your Information:

* indicates a required field

IS THIS AN EMERGENCY ORDER?
YES NO
IF YES, PLEASE COMPLETE FORM, SUBMIT, AND CONTACT Anna Juvennelliano @ ABOVE NUMBERS ASAP.

Today's Date:

Your E-mail:*

Your First Name:*

Your Last Name:*

Department Name:*

Your Telephone #:*

Index #:*

Other Contact #:

Indicate Article:

Blood, Medication. Equipment, Mail, Package, Etc.

Insert # of Parcels:

Is a quote for this delivery service requested?

Yes No

Is a confirmation for this delivery service requested?

Yes No

Item(s) Departing From:		Items(s) To Be Delivered to:
Item(s) Departing From:	(contact name)	Items(s) To Be Delivered to:	(contact name)
Telephone #:		Telephone #:
Campus /Street/ Town, Address:		Campus /Street/ Town, Address:
Building Name:		Building Name:
Floor #:		Floor #:
Room #:		Room #:
Department Name:		Department Name:
Pick-up Date:		Delivery Date:
Pick-up Time:		Delivery Time:
*************************************************************************************************************
Additional Information: Hand Delivery, Signature Required, Urgent Delivery, Etc.: