{% load static %} {% load settings %}
Shipper's Name: | DATE | ||
CLSI Department: | {{admin_project.department|cut:"None"|default:""}} | {% now "F d, Y" %} | |
Account #: | |||
Phone: |
SHIP TO: (Consignee) |
Company's Name: | {{ project.department|cut:"None"|default:"" }}, {{ project.organisation|cut:"None"|default:"" }} |
Street Address: | {{ project.address|cut:"None"|default:"" }} |
City / State / Province: | {{ project.city|cut:"None"|default:"" }}{% if project.city and project.province %} ,{% endif %}{{ project.province|cut:"None"|default:"" }} |
Country / Postal Code: | {{ project.country|cut:"None"|default:"" }}, {{ project.postal_code|cut:"None"|default:"" }} |
Att: (Contact Person) | Phone Number | |||||
{{ project.contact_person|cut:"None"|default:"" }} | {{ project.contact_phone|cut:"None"|default:"" }} | |||||
Consignee's Courier | Courier Account # | Federal Tax Number (USA) | ||||
{{ project.carrier.name|cut:"None"|default:"" }} | {{ project.account_number|cut:"None"|default:"" }} | |||||
□ On Loan | □ Chargeable Repair | □ Return to Vendor | ■ Return to Owner | |||
□ Return of Loan | □ US Goods Returned | □ Warranty Repair | □ Other (explain below) | |||
RMA# | Other: | |||||
QTY | DESCRIPTION | Country of Origin | Total Value | |||
Non-Hazardous Frozen Protein Samples in Dry Shipping Dewar | {{ project.country|cut:"None"|default:"" }} | $200 | ||||
H.S. Code: | ||||||
Total Items | Shipment Weights | TOTAL: | $ | |||
KGS □ LBS □ Total Weight |
USD$□
CAD$■
Euro$□ Other □ (explain below) | |||||
Does this shipment contain any of the following hazards? |
Yes | No | Yes | No | Yes | No | |||||||
Explosives | □ | ■ | Flammable Liquid | □ | ■ | Poisonous Material | □ | ■ | ||||
Flammable | □ | ■ | Combustible Liquid | □ | ■ | Poisonous Gas | □ | ■ | ||||
Corrosive Material | □ | ■ | Flammable Solids | □ | ■ | Radioactive Material | □ | ■ | ||||
Organic Peroxides | □ | ■ | Dangerous-When-Wet | □ | ■ | Oxidizer | □ | ■ | ||||
Infectious Substance | □ | ■ | Spontaneously Combustible Liquid | □ | ■ | |||||||
Lithium Metal Battery | □ | ■ | Nonflammable Compressed Gas | □ | ■ | |||||||
Lithium Ion Battery | □ | ■ |