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Must be legibly filled in,in Ink indelible Pencil,or in This Shipping Order Carbon,and re by the agent Shipper No. Carrier No. Page of Date ✓� f (Name of carrier) (SCAC) On Collect on Delivery shipments,the letters"COD"must appear before consignee's name or as otherwise provided In Item 430,Sect. FROM: TO: Shipper -- Consigns Street Q T4 Street �, 9 , City f State Zip Code City State, Zip Code 4�,5��' 24 hr.Emergency Contact Tel.No. Route Vehicle Number No:of Units BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES &Container Type Proper Shipping Name,Hazard Class UN or NA Number,Proper Shipping Name, (Weight, Volume, (Subject to RATE (For Carrier Uor N or NA Number,Packing Group Hazard Class,Packing Group Gallons,etc.) Correction) Use Only) PLACARDS TENDERED: YES O NO p REMIT Note— 1 Where the rete Is q y ADDRESS SS O dependent on value,shippers are required ro state i hereby declare that the contents of this ADDRESS specifically in writing the agreed or declared value of the property,as follows:'rhe consignment are fully and accurately agreed or declared value of the property is hereby specifically stated by theshipper to described above by the proper shipping C.O.D.FEE: be notexceeding per name and are classified, packaged, C®® Amt: $ - - PREPAID ❑ (2)where the applicable tariff provisions specify a limitation of the carders liability absent marked and Iabelledtplacarded,and are COLLECT ❑ $ a release or a value declaration by the shipper and the shipper does not release In all respectsin proper.condition for the canter's liability or declare a value,the canter's liability shall be limited to the extent transport according to applicable Subject to Section 7 of the corxations,If this shipment Is to be delivered to the TOTAL provided by such provisions.See NMFC Item 172, International and national governmental fconollowisigng statement:without recourse on the consignor,the consignor shell sign the CHARGES $ (3)Commodities requiring special or additional care or attention in handling or slowing regulations. The carder shall not make delivery of this shipment without payment of FREIGHT CHARGES must be so marked and packaged as to ensure safe transportation.See Section 2(e)of freight and all other lawful charges. FREIGHTPREPAID Check boz H Merges Item 360,BillsofLading,Freight Bilis and Statements of Charges and Section 1(a)of FREIpGtwhenbozet ererobe the Contract TermsandConditions for a list of such articles. Signature (skIsaturs m oaos dgM h dcecked ceaect -RECEIVED,subject to the classifications and tariffs in effect on the date of the Issue of this BIH of Lading, gnelion and as to each party at any 6me Interested in all or any said property,that every service to be the property described above In apparent good order,except as noted(contents and condition of cwt- performed hereunder shall be subject to all the bill of lading lens and conditions In the governing clan- . tents of packages unknown),marked,carsigned,and destined as indicated above which said caller siflcalbn on the date of shipment. (the word caller being understood throughout this contract as meaning any person or corporation in - Shipper hereby certifies that he is familiar with all the lading terms and conditions in the possession of the property under the contract)agrees to carry to Its usual place of delivery at said deso- - goveming classification and the said terms and conditions are hereby agreed to by the shipper and nation,H on its route,otherwise to deliver to another caller on the route to said destination.It is mule- accepted for himself and his assigns. ally agreed as to each carder of all or any of,said property over all or any portion of said route to des- SHIPP R CARRIER G PER ,JJ P -7 1'& DATE . Permanent post-office address of shipper. _ A STYLE F365-3 0 2003 LABELMASTER 0 (800)621-5808 www.labelmaster.com