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Uarbon,and retained by the agent Shipper No. .-'-��•Z,.;�' / Carrier No. Page �� of /.gil�.�� Z— / � Date (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,Sec.t. FROM: TO: Shipper Consignee I�� Street ��//' ' �// C`tYJ�' State� Zip Code �� City �/State, ,r Zip Code 7 24 hr.Emergency Contact Tel.No. Route Vehicle n� Number No.of Units HIVI BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES &Container Type Proper Shipping Name,Hazard Class UN or NA Number,Proper Shipping Name, (Weight, Volume, (Subject to UN or NA Number,Packing Group or Hazard Class,Packing1 RATE (For Carrier f� / Group Gallons,etc.) Correction) Use Only) PLACARDS TENDERED: YES o NO O REMIT C.O.D.TO: Note—(1)Where the rate is dependent on value,shippers are required to stale I hereby declare that the contents of this ADDRESS specifically In writing the agreed or declared value of the property,as follows:"The consignment are fully and accurately agreed or declamd value of the property is hereby spedficaNy stated by the shipper to described above by the proper shipping be not exceeding per name and are classified, packaged, C.O.D.FEE: (2)Where the applicable tariff provisions specify a limitation of the carrier's Itabllify absent marked antl Iabelled/placarded,and are COD Amt: $ PREPAID L7 a release or value declaration by the shipper and the shipper does not release In all respects In proper condition for COLLECT❑ $ the carrier's liability or declare a value,the carrier's liability shall bit limited to the extent transport according to applicable Subject to section 7 ai the conditions,if this shipment to be delivered tp the TOTAL provided by such provisions.See NMFC Item 172. international and national govemrnen,al consignee without recourse on the consignor,the consignor shall sign the CHARGES $ (3)Commodilies requiring special or additional care or attention in handling or stowing regulations. fdlor)stam teent: _ must be so marked and packaged as to ensure safe transportation.See Section 2 e of The carrier shall not ke delivery of this shipment without payment of FREIGHT CHARGES �— P 9 P () The and all other lawlul charges. Item 360,Bilis of Lading,Freight Bills and Statements of Charges and Section 1(a)of FREIGHT PREPAID Check box if charges the Contract Terms and Conditions for a list of such articles. Signatureexcept when box at I�I are lobe (Signature of Gons,gnorl right Is checked i J c-Netl RECEIVED,subject to the classifications and tariffs in effect on the dale of the issue of this Bill of Lading, - tination 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 corn performed hereunder shall be subjeel to all the bill of lading terms and conditions In the governing clan. tents of packages unknown),marked,consigned,and destined as indicated above which said carrier sification on the dale of shipment. (the word carrier being understood throughout this contract as meshing 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 its route,otherwise to deliver to another carrier on the route to said destination.It is mutu- 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. SHIPPER l CARRIER PER P CR as - 2 DATE 0,,7- Permanent post-office address of shipper. �T — 1 STYLE F365-3 02003 LABELNIASTER® (800)621-5808 www.labelmaster.com