Courier Pick-up

	Your Name*

	Your Email Address*

	Account Number (if you pay cash please type "CASH" and "CREDIT CARD" if you pay Visa, Master Card. *

	Sender's Name *

	Sender's Reference (not obligatory, first twelve characters will be shown)

	Company Name

	City (online pick up booking is avaliable only in the following cities)*		KyivOdesaDnipropetrovskLviv

	Address (enter detailed address please) *

	Post Code *

Contact by*    Phone  Fax  Telex		phone/ fax/ telex number*

	Date pickup required:*

Shipment ready:*		Closing time:*

	Company Name*

	Delivery Address (only city and country required). DHL cannot deliver to a PO Box

Post Code		phone/ fax/ telex number*

Number of pieces		Weight in kilograms*

	Shipment declared value		less that 100 EUR  more than 100 EUR

	Full description of contents