| Your Name | Name of the person transferring the records. You must be authorized to request services. |
| Your E-mail Address | E-mail address of person transferring the records. |
| Service Needed | Pick one of three: Retrievex Delivery:To have records delivered from Retrievex to your office. Access at Retrievex:To view records at the Retrievex warehouse. Retrievex Pick-up:To return records from your office back to Retrievex. |
| Date Requested | Today's Date. |
| Delivery Requested | Pick one of three: Next Day:Next business day delivery-least expensive option. Same Day:Same day delivery within 4 hours. Emergency:Same day delivery within 2 hours. |
| Account Name | Retrievex This may be the same as your department name or it may be different if one account is shared within multiple office or an entire division. |
| Account Number | Retrievex account number of the office or department being charged for Retrievex services. |
| Phone Number | Contact number to reach the person requesting retrieval or return. |
| Barcode Number(s) | Fill in the number of the barcode label that you placed on the box when it was originally shipped to Retrievex. Please note that it is less expensive to have an entire box delivered to your office than an individual file folder. |
| File Name | Same offices choose to retrieve only one file folder rather than a whole box. In these cases, enter the title of the folder. |
| File Number | If you are requesting an individual folder, fill in the number of the folder within the box it is housed. |
