Rutgers Environmental Health and Safety
REHS Shipment Request Form
Shipper Information
Name
Department/Lab
Street Address
Phone
E-Mail
Destination Information
Name
Company/University
Phone
Address Line #1
Address Line #2
Country
City
State/Providence
Zip Code
Materials Being Shipped
  Yes No
Chemical
Radioactive
Biological
Genetically Modified
Dry Ice
Cold Pack
Comments