Form

Package Delivery Information

Delivery Pricing: $1.00 PER MILE, $10 minimum delivery fee, and +$2 medical handling fee (FOR PRESCRIPTIONS OR SENSITIVE ITEMS. Enter your pickup and drop off locations below to calculate your estimated cost.
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Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Pick-up Address

Street Address

Street Address Line 2

CityState

Zip Code
Package Distributor Number
Please enter a valid phone number.

Payment Amount

USDDescription

Package Delivery Information