Select Insurance Option
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1. Uninsured.
2. Insured up to $5000.00 for $75.00
Name / Company
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
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example@example.com
Questions or Comments
To John W Franks: I hereby authorize you to leave my package with USPS / FedEx / UPS. I understand and agree that by signing this, I release John W Franks from any and all liability for loss or damage once the package is turned over to the carrier and proof of shipping and tracking is given to the signee. If insured all claim payments will be given to the signee of this release.
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Print Signature
Signature
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Date
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-
Month
-
Day
Year
Date
Submit
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