Form: Customer's Drop Ship Order

1.- 

Order Number: *

2.- 

Purchaser's Full Name: (Name, Middle Name and Lastname(s)) *

3.- 

Delivery: Receiver's Full name (Name, Middle name and Lastname(s))*

4.- 

Delivery Address: (Street address, City, State, Zip)*

5.- 

Delivery Address is:*

6.- 

Only for Parcel: Signature Required?

7.- 

Freight Accesories Required: (Only for Freight and select all required)

8.- 

By signing your name below, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement between you and American Sulastic, Corp to deliver your item's order on a different address than the billing address.*

9.- 

Attach a copy of your Driver's License? * The name must match with the name as shown on the method of payment. Why? because is not being shipped to the credit card's billing address and/or the amount of the transaction.