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Delivery Release Agreement
(www.clean-usa.com)


Please print and complete this form and then place a signed original in a location that is both visible and accessible to the delivery person. Please note: This Delivery Release Agreement must be completed for each shipment in your order.

Date: ___________________   Order Number: ______________

 

Authorized Signature: _____________________

 

Print Authorized Signer's Name: __________________________

 

Print Address: ________________________________________

                          ________________________________________

                          ________________________________________

I understand that my signature authorizes the delivery person to leave my shipment at my address even if no one is available to accept it. I also understand that Clean-USA and the delivery company is not liable for any loss or damage that may result from the delivery request I have made in this agreement.

Please note: In certain instances, your order may not be suitable for delivery release. The delivery person will leave a note with instructions on how to receive your order.


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