Shipment Release Authorization Form - National Delivery Systems

"*" indicates required fields

National Delivery Job #*

Pro#*

Terminal*

Name*

Address*

City*

State*

Zip Code*

Email*

Special Instructions*

By completing this form, I am requesting that National Delivery leave the shipment at the location indicated above. As a result of this request I hereby release National Delivery and their driver or contractor from any and all liability. This release includes any loss or damage to the product being delivered along with any personal or public property damage that may occur as a result of the delivery to include but not limited to; driveways, landscaping, utilities, structures, mailboxes, lawns, etc.

I request that my shipment be released without signature by completing the driver license information below:

Driver License #*

State*

Exp. Date*

All deliveries are subject to the driver's discretion for safety and security reasons. Shipments can only be released to the address indicated on the Bill of Lading.

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Phone

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