In order to have Crown Works Laboratory pay for the shipment:

1. Mark the Bill Receiver box in section 3. Fill in our account number on the green line after Bill to:    (call 1-888-522-8324 to request our account number).

2. Put the number 1 under weight in section 6.

3. Put an X in the blue box that says "Next Afternoon".

4. Complete section 1 as follows.

Your Company Name
Street Address
City, State, Zip Code
Contact Person, Phone number

5. Complete section 2 as follows.

Crown Works Dental Laboratory
PO Box 89
Oakland, OR 97462
541-459-5134