Your Name (required)

Your Email (required)

Phone

Description Of Package ( Barrel,Box,Other-Name The Other)*

Number Of Packages

Package Identification Code*

Recipient’s Name*

Recipient’s Phone Number*

Alternative Recipient’s Name*

Alternative Recipient’s Phone Number*

Value Of The Goods Being Shipped $*

I Would Like To Insure My Goods Against Total Loss @ 10% The Value Of The Goods. (Check YES Or NO)*

YesNo

I further declare that my package or packages being shipped from the United States of America to Zambia does not contain any illegal drugs or hazardous materials such as explosives, firearms, gunpowder, liquid propellant, liquefied gas or flammable liquids like perfumes or colognes. Do you Agree?

Yes I Agree
Shipper’s Signature (Please Print Your Full Name)*