By signing above, Sender agrees to
all terms and conditions as stated on this form (see reverse) and authorizes Suisun Valley Business Solutions, LLC (“SVBS”) to ship this parcel. Sender agrees to observe all local, state, and federal regulations and further certifies that he or she is not an officer of the law or affiliated with any agency using this information for the purposes of entrapment. SVBS’ declared value/insurance does not cover: heat, cold, foil, label damage, or any pre-packaged orders. By signing, Sender authorizes SVBS to charge the credit card on the form or on file for all shipping fees based on the quote provided.