Preprinted waybills
To order your preprinted waybills, please fill in the following form just as you would complete an actual Dicom Express waybill. Leave any areas that you do not want preprinted empty. Sections shaded in gray are not available for preprint and are shown for reference purposes only.

PORT PAYÉ
PREPAID 		 COMPTE DICOM ACCOUNT
  		 DÉPARTEMENT / DEPARTMENT
  		COMPTANT
CASH
 EXPÉDITEUR / SENDER
  		 TÉLÉPHONE / TELEPHONE
()
 COMPAGNIE / COMPANY
 
 ADRESSE / ADDRESS
 
 VILLE / CITY
  		 PROVINCE
  CODE POSTAL CODE

PORT DÛ
COLLECT 		 COMPTE DICOM ACCOUNT
  		 DÉPARTEMENT / DEPARTMENT
  		COMPTANT
CASH
 DESTINATAIRE / CONSIGNEE
  		 TÉLÉPHONE / TELEPHONE
()
 COMPAGNIE / COMPANY
 
 ADRESSE / ADDRESS
  		 Nos de boîte postale non acceptés
 Post office box not acceptable
 VILLE / CITY
  		 PROVINCE
  CODE POSTAL CODE
 COMPTE DICOM ACCOUNT
 
 COMPAGNIE / COMPANY
 ÉTIQUETTE DE CODE À BARRES DEXTRAK ET/OU INSTRUCTIONS SPÉCIALES
 DEXTRAK BARCODE LABEL AND/OR SPECIAL INSTRUCTIONS
 
 VALEUR DÉCLARÉE
 DECLARED VALUE
  		 SUPPLEMENT DE 3%
 Sur VALEUR DECLAREE
 100 $ A 5000 $ MAX OU
 LIMITATIONS DE
 RESPONSIBILITE
 4,41 $ / KG MAX		  3% SURCHARGE ON
 DECLARED VALUE
 $100 TP $5,000 MAX OR
 LIMITATIONS OF
 LIABLILITY
 MAX $4.41 / KG
Before submitting your order, please check your preprint information carefully. By clicking "check waybill", you can review your entries in a waybill pop-up window. Simply click back here to make any corrections.
 
  number of preprint
waybills requested
Send waybills to
Please select or enter where you want your waybill order to be delivered. To receive an email order confirmation, please include your email address.
  use address
from "Sender" on waybill
other (enter below)
 
 
 
 
 
 
  / province
  email
  ext.
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