Domestic Confirmation of Receipt

Domestic Confirmation of Receipt

Humanitarian Aid Shipment - Effective 1/8/2026
Organization Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Bill of Lading/Reference #:*
Please upload Bill of Lading or Proof of Receipt*

If you are unable to provide the BOL or proof of receipt, please upload a document with explanation
Cancelof
Please upload Packing Slip

Cancelof
I hereby confirm that we have received the donated cargo as listed in the associated packing list with the exception of any discrepancies noted below.
Total Case Qty Received*
Total Pallet Qty Received*
Board Pallet Qty Received*
Board pallets are wooden and brown. If none, input 0
PECO Pallet Qty Received*
PECO pallets are red with white lettering. If none, input 0
iGPS Pallet Qty Received*
iGPS pallets are black and plastic. If none, input 0
CPC Pallet Qty Received*
CPC pallets are red with black lettering. If none, input 0
CHEP Pallet Qty Received*
CHEP pallets are blue with white lettering. CHEP pallets must be carefully tracked. If none, input 0
CHEP Account Number
If you do not have a CHEP account number yet, please submit 99999 as your CHEP account number
Total Gross Weight (Pounds)*
Do not subtract pallet weight
Cargo Description*
Shipment Received Date*

MonthDayYear
Date
City of Receipt*
State of Receipt*
Any damages or discrepancies?*

YesNo
List any items damaged or any discrepancies*
Digital Signature*
Title*
Email*
example@example.com
Should be Empty: