"*" indicates required fields Delivery Docket / Receipt / POCollect From (Manufacturer)Company Name* Contact Name* Contact Phone* Company Phone* Email* Purchase Order Number (If Applicable)Reference Number: Project Name (If Applicable)Manufacturer Acknowledgement I acknowledge I have checked the items listed below which are leaving the premises in good condition. I have checked the items for damage or indiscrepancies. I have signed below to approve the delivery can proceed. I will not sign this due to damage or discrepancies (add notes below).Does the total value of goods being delivered exceed $500,000?* No Yes IMPORTANT: Each delivery is capped at $500,000. Switchboard deliveries that exceed this cap will require additional insurance cover. Please check all switchboards are correctly valued and are under $500,000 in total per delivery, to ensure insurance is not exceeded and void.Name* First Last SignatureDate Signed (Pickup Date) DD slash MM slash YYYY Pickup Time Hours : Minutes AM PM AM/PM Date of Preload (if applicable) DD slash MM slash YYYY Preload Time Hours : Minutes AM PM AM/PM Delivery Date DD slash MM slash YYYY Delivery Time Hours : Minutes AM PM AM/PM NotesCustomer DetailsCustomer Name* Office Phone* Customer Email Delivery Site Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Gate Number Port Number Bay Number Contact Person On-site* Contact Mobile Contact Person For Traffic Control Contact Mobile: Project Builder Business Trading Name E.g. HutchinsonNotesDescription of SwitchboardsDescription of Switchboards Item Description Colour QTY Length Weight Width Height Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Received By (Customer)I acknowledge I have received the items above. I have checked the items for damage or indiscrepancies. I have signed below to approve the delivery. I will not sign this due to damage or discrepancies (add notes below).SignatureDate DD slash MM slash YYYY Time Hours : Minutes AM PM AM/PM NotesSwitchboard TranzDriverJason FlynnMark JessopJohn LedgardPhotos Drop files here or Select files Max. file size: 256 MB. Δ
