Please fill in this form if you are arranging a pick-up from our Click & Collect location points with a third-party person or courier service.

Date of Pick Up:*

Pick up Location

Section 1: Customer Details

Sales Order No:

Email:

First Name

Last Name

Address

State

Suburb

Postcode

Mobile

Section 2: Authorised 3^rd Party Pick Up Details

Full Name/Company Name:

Consignment No.: (if applicable)

Section 3: Authorisation

I authorise the nominated person in Section 2 to act on my behalf for pick up.

IMPORTANT: Customers are required to attach their drivers license or photo I.D for account identification. Please note that the account holder is the person registered to have purchased the item from Lifespan.

Person picking up the item on behalf of the account holder needs to provide Lifespan with a photo I.D for approval purposes.

Add Attachments

Section 1: Customer Details

Section 2: Authorised 3rd Party Pick Up Details

Section 3: Authorisation

Section 2: Authorised 3^rd Party Pick Up Details