Sender Recipient 3rd person

-- Select -- aly blvd line microdistr emb ln sq psge cor ave lck str hwy rd

Date

Time

-- Select -- no payment required payment confirmation document payment at handling required, total

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от

-- Select -- DIMEX courier’s identification document Power of Attorney letter for DIMEX courier Requestor’s Power of Attorney letter original Power of Attorney letter or other document issued by Requestor and to be sent by fax Other

-- Select -- Express Economy Door-to-Door Economy Door-to-Warehouse Economy Warehouse-to-Door Economy Warehouse-to-Warehouse City postage Other

-- Select -- Dangerous Glass Fragile Liquid Aerosol Other

-- Select -- package-free bags cardboard boxes wooden boxes jerricans crate palletized Other

-- Select -- pallets crate Other

-- Select -- aly blvd line microdistr emb ln sq psge cor ave lck str hwy rd

-- Select -- requestor sender recipient Other

-- Select -- cash bank transfer

-- Select -- yes no

-- Select -- yes no