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• • is Memorandum is an acknowledgment that a Bill of Lading has been issued and is not Original Shipper No. �Zi_2 ~: Bill of Lading,nor a copy or duplicate,covering the property named herein,and is I intended solely for filin or record. -�~ Carrier No. 3e � of � �hOP ��I�.bS � �U�iy�JS 1ivC- �Ll (Name of carrier) (SCAC) Date )[fact on Delivery shipments,the letters°COD°must appear before consignee's name or as otherwise provided In Item 43 Sec.t. FROM. I Shipper si nee, Lor' 1CrJ✓" 12r''!.�!/ f ' ,�%/' 9�/7�S^ Street yQ?!�" �- I d f ;SxIt,'4 et 1�) ,� siJ city State� Zip Codes`2/� L,26,< State(?o Zip Code 9 fag/ 24 hr.Emergency Contact Tel.No. Vehicle to Number BASIC DESCRIPTION TOTAL OUANTITY WEIGHT CHARGES Vo.of Unitsu A Proper Shipping Name,Hazard Class o� UN or NA Number,Proper Shipping Name, (Weight, Volume, (Subject to RATE (For Carrier Dontainer Type H M UN or NA Number,Packing Group Hazard Class,Packing Group Gallons,etc.) Correction) Use Only) i i i i i I PLACARDS TENDERED: YES O NO 17-1 REMIT 1 Where the rate is dependent on value,shippers y declare that the contents of this C.O.D.TO: i () p peers are required s:state I consignment ADDRESS tally in writing the agreed or declared value of the property,as follows:'The consignment are fully end accurately I 1 or declared value of the property is hereby specifically stated by the shipper to described above by the proper shipping C.O.D.FEE: ! exceeding per name and are classified, packaged, PREPAID ❑ .ere the applicable tariff provisions specify a limitation of the carrier's liability absent marked and IabelleNplacarded,and are D Amt' $ COLLECT ❑ $ ase or a value declaration by the shipper and the shipper does not release in all respects in proper condition for mer's liability or declare a value,the carrier's liability shall be limited to the extent transport according to applicable Subject to Section 7 of the conditions,if this shipment is to be delivered to the TOTAL I sd by such provisions.See NMFC Item 172. international and national governmental consignee with recourse on the consignor,the consignor shall sign the CHARGES $ following statement: mmodilies requiring special or additional care or attention in handling or stowing regulations. The carrier shall not make delivery of this shipment without payment of t eso marked and packaged as to ensure safe transportation.See Section 2(e)of freight and all other lawful charges. FREIGHT CHARGES I{I FREIGHT PREPAID Check box M charges So,Bills of Lading,Freight Bills and Statements of Charges and Section 1(a)of exceptwhen box at aro to be ntract Terms and Conditions for a list of such articles. Signature (signature of Consignor) right,, checked ❑ collect I RECEIVED,subject to the classifications and tariffs in effect on the date of the issue of this Bill of Lading, tinatlon and as to each pang at any time interested in all or any said property,that every service to be C the property described above in apparent good order,except as noted(contents and condition of con- performed hereunder shall be subject to all the bill of lading terms and conditions in the governing clas- tents of packages unknown),marked,consigned,and destined as indicated above which said carrier sification on the date of shipment. (the word carrier 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 desti- governing classification and the said terms and conditions are hereby agreed to by the shipper and nation,if on its route,otherwise to deliver to another carrier on the route to said destination.It is mutu- accepted for himself and his assigns. j ally agreed as to each carrier of all or any of,said property over all or any portion of said route to des- `( 'PER ��' CARRIER F A n , i PER - i DATE . j a st-office address of shipper. STYLE F360-4 C 2003 LABEAASTFR0(800)621-5808 www.labelmaster.com l - i