Request IMMEX USA Overseas Buyers Assistance |
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Requestor Information |
* Required Fields |
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* First Name : |
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* Last Name : |
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* Phone # : |
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* Email Address : |
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USA Account # (If available) : |
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* Address One : |
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Address Two : |
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Address Three : |
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* City : |
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State and Zip Code : |
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* Country : |
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* Preferred Delivery Method : |
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* Preferred Payment Method : |
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OBS Purchase Request # 1 COMPULSORY |
Enter Website Link : |
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Enter Quantity : |
numbers only |
Enter Additional Details such as color, size, etc : |
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OBS Purchase Request # 2 OPTIONAL |
Enter Website Link : |
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Enter Quantity : |
numbers only |
Enter Additional Details such as color, size, etc : |
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OBS Purchase Request # 3 OPTIONAL |
Enter Website Link : |
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Enter Quantity : |
numbers only |
Enter Additional Details such as color, size, etc : |
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OBS Purchase Request # 4 OPTIONAL |
Enter Website Link : |
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Enter Quantity : |
numbers only |
Enter Additional Details such as color, size, etc : |
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OBS Purchase Request # 5 OPTIONAL |
Enter Website Link : |
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Enter Quantity : |
numbers only |
Enter Additional Details such as color, size, etc : |
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OBS Purchase Request # 6 OPTIONAL |
Enter Website Link : |
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Enter Quantity : |
numbers only |
Enter Additional Details such as color, size, etc : |
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I hereby authorize Immediate Couriers LLC to claim shipments from American Merchants directed by me to the Immediate Courier’s USA Office for delivery into the United Arab Emirates. |
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Date of Order : |
(mm/dd/yyyy) |
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* Validation Code : |
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write the characters from the above image |
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