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
2 digit month, 2 digit day, 4 digit yearDate
City of Receipt
State of Receipt
Any damages or discrepancies?
List any items damaged or any discrepancies
Digital Signature
Title
Email
example@example.com
Should be Empty: