RLH Mail Services Proxy Package Pickup Form
By signing this form, I understand that once any package(s) is/are released to the person listed as a "proxy" on this form, I am releasing Residential Life and Housing from any and all liability regarding the delivery of the listed package(s) and that I am responsible for coordinating with and retrieving my package(s) from said person.
Proxy's Name
*
First Name
Last Name
Proxy's Email Address
*
Confirmation Email
example@example.com
Proxy's Phone Number
*
Proxy's V-Number (if applicable)
Ex. V00812345
Your Name
*
First Name
Last Name
Your VCU Email Address
*
Your V-Number
*
Ex. V00812345
Tracking Number(s) of the package(s) you would like the listed Proxy to pick-Up
*
Please input each Tracking Number separated by a comma
Your Signature
*
Submit
Should be Empty: