Authorization To Pay Federal Express Charges

Fields marked with an * are required.

Shipping Notification:
    • Ex: 8/26/09
    • Ex: Letter
    • Ex: 123456789012
    • Ex: 18
    • Ex: Purchasing
    • Ex: 24501
    • Ex: 539600 - Postage
    • Ex: Ed Gautier
    • Ex: 8/26/09
Affirmation of Receipt
  • I certify the Federal Express service provided has been performed satisfactorily:

  • Note: Fax or mail a copy of airbill to the Purchasing Department. Purchasing will attach airbill to AUTHORIZATION TO PAY form. Fax to 3810 or mail to Box 10800.

    Submit completed form and airbill copy to the Purchasing Department no later than (1) working day following shipment or charged delivery.


Please enter the letters that you see in the Captcha image into the field below. This is an anti-spam measure that verifies that the person submitting the form is a real person and not a computer program.