Lithium Battery Shipping Request

Contact Information

Contact Name*
Contact Email*
Business Name
Address*
City*
State*
Zip*
Country*
Residential or CommercialResidentialCommercial
Phone*

Recipient Information

Recipient Contact Name*
Recipient Business Name
Recipient Address*
Recipient City*
Recipient State*
Recipient Zip*
Recipient Country*
Recipient Residential or CommercialResidentialCommercial
Recipient Phone*

Battery Information

Battery Information:
Attach TDS/SDS*
Attach Photo
Battery Type*

Please specify*

Watt-Hours
Number of Cells
Battery Value*
Weight of Battery*
Dimensions of Battery*
Packed in equipment?YesNo
Timeline (requested delivery date)