SCRIP Courier Consent Form for FVL
Please direct any questions to the
FVL SCRIP Office
Courier / Student Information
Please list the FIRST AND LAST names of your designated SCRIP Courier(s)
Click the + to add more names.
SCRIP Account Holder Consent
I understand that I am giving my consent for the above-listed couriers to pick up my FVL SCRIP orders from the date of this form and forward. If I have changes to this consent, I will fill out a new form.
Type your electronic signature below.
This document is being submitted by the account-holder and is the person whose electronic signature is above.
This document must be submitted by the account-holder. If you are not the account-holder, this document is invalid and will not be honored.
Email of person completing form
Comments or Questions?
Comments, questions, or additional information that needs to be shared.