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This $hl Itl Order Must De legl�ly nuea In, in mK maeive rencii, or In PP 9 Carbon, and retain d by the agent Page of (Name of carder) (SCAC) Shipper No:�'�%'� Carrier No. Date On Collect on Delivery shipments, the letters"COD" must appear before consignee's name ores otherwise provided in Rom 430, Sec.t. FROM: TO: Shipper Consignee Street Street., G i��, % J`i' r ;T�!� �� jy�� City ze' State �'� . Zip Code 2 /� Zip Code -V 24 hr. Emergency Contact Tel. No. Route Vehicle Number No. of Units & Container Type BASIC DESCRIPTION Proper Shipping Name, Hazard Class UN or NA Number, Proper Shipping Name, UN or NA Number, Packing Group or Hazard Class, Packing Group TOTAL QUANTITY (Weight, Volume, Gallons, etc.) WEIGHT (Subject to Correction) RATE _ CHARGES (For Caller Use Only) slBcotion on the date of shipment - (the wont 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 dealt- governing classification and the said terms and conditions are hereby agreed to by the shipper and nation, if on iftsraffe, otherwise to deliver to another caller on the route to said destination. It Is muhf- accepted for himself and his assigns. ally agreed t ach carrier of all or any of, said property over all or any porton of said route to des- - SHIPPER CARRIER,: PER %- / PER L/ i"11 BATE Permanent post -office address. of shipper._ - PRINTED ON RECVCLEO PAPER STYLE F365-3': ®'2003 LABELMASTERO (80a).621-5808 www.labelmaster.com rnimvmm PLACARDS TENDERED: YES o NO Em REMIT C.O.D. TO: ADDRESS Note — (1) Where the rate Is dependent on value, shippers are required to. state specifically in writing the agreed -or declared value of the property, as follows: 'The agreed or declared value of the property is hereby specifically stated by the shipper to be notexceeding per (2) Where the applicable tariff provisions specify a limitation of the carrier's liability absent a release or a value declaration by the shipper and the shipper does not release the carrier's liability or declare a value, the canter's liability shag be limited to the extent provided by such provisions. See NMFC Item 172. 3 Commodities requiring s ecial or additional care or attention in handling or stowing O P 9 9The must be so markedandpackaged as to ensure safe transportation. See Section 2(e) of R Item 360, Bills of Lading, Freight Bills and Statements of Charges and Section 1(a) of the Contract Terms and Conditions for a list of such articles. I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name and are classified, packaged, marked and labelled/placarded, and are in all respects M proper condition for transport according to applicable International and national governmental regulations. - Signature C®® Amt: C.O.D. FEE: PREPAID ❑ COLLECT ❑ $ Subject to Section 7 of the conditions, R this shipment Is to be delivered to the conslcee without recourse on the consignor, the consignor shall sign the follow ng statement: carrier shell not make delivery of this shipment without payment of freight and all other lawful charges. TOTAL CHARGES $ FREIGHT CHARGES I FREIGHT PREPAID Check box g FREIGHT except When box fight h checked at ❑ collect (Signature of Conslgnw) RECEIVED, subject to the classifications and tariffs in effect on the date of the Issue of this Big of Lading, tinetion and as to each party at any time 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 con- performed heunder shag be subject to all the bill of lading terms and conditions In the governing cl- ients of packages unknown), marked, consigned, and destined as Indicated above which said carrier slBcotion on the date of shipment - (the wont 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 dealt- governing classification and the said terms and conditions are hereby agreed to by the shipper and nation, if on iftsraffe, otherwise to deliver to another caller on the route to said destination. It Is muhf- accepted for himself and his assigns. ally agreed t ach carrier of all or any of, said property over all or any porton of said route to des- - SHIPPER CARRIER,: PER %- / PER L/ i"11 BATE Permanent post -office address. of shipper._ - PRINTED ON RECVCLEO PAPER STYLE F365-3': ®'2003 LABELMASTERO (80a).621-5808 www.labelmaster.com rnimvmm