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On Collect w Def"ry shipments,the lettere"COD'must appear before wnsignea's n, s otherwise provided in ham 430;See.1. FRO161: ,!' TO: - Scupper t` s'. Consignee L � 'Y.t" 'r" - r Stree�;�*,r� Street .+'� d Cit li r State Zip Code --74P CR +�� State Zip Code:° ^5 Les ter.Emergency Contact Toi.No. Vehicle Route Number BASIC DESCRIPTION TOTAL OUANTITY WEIGHT CHARGES No.of Unitsg ��(AA Proper Shipping Name,Hazard Class ur UN or NA Number,Proper Shipping Name, (Weight, Volume, (Subject to RATE (For Carrier &Container Type I- M UN or NA Number,Packing Group Hazard Class,Packing Group Gailons,etc.) Correction) Use Only) PLACARDS TENDERED: YES t1 NO C7 REMIT C.O.D. Note—(1)Where the rate is depwxlent on value,shippers are required to state I thereby declare that Ute w ltwm of this ADDRESS sperirrally in willing the agreed or declared value of the properly.as follows:"the consignment are fully and accurately agreed.1 declared value of the property is hereby specifically stated by the shipper to described above by the proper shipping C.O.U.FEE: be net exceeding_,,.... nano and are.classified. packaged, CO© Amt: $ PREPAID ❑ per (2)What"file applicable tank provisions specify a lienhation of the canior s liability absent rnerKetl and fabenetlfpiaranJed,and are COLLECT 0 $ o release aro value dodarahon by.ilia stepper and the shipper dao.trot release In an raspecL in proper wndinon for Ill.carriers liability or declare a value,ilia carriers liabilly shad be limited io the indent transport according to applicable S.biccl to$cxtkv+7 or ine condifiora,ii ids shipment a to tie de4vamd to cite TOTAL provided by such pmvisiwa.See NEAFC Item 172, inlemational slid national governmental coni without recons,on in,.coni gear,the cat-ion-1 shed sign the CHARGES $ statomerrt (3)Cotrrtnodit)es requirkg special a additional will or attention in handling fee owmg w sieving regul,tions. 7iw Gtrrier stall not make delivery of crus sltipmom vnawut payment d FREIGHT CHARGES must be so marked and packaged as to ensure sale Inimportation.See Section 2(e)of ireigtu are all ether hetet cnaigns. FKEIGNT PREPAID Chadr box ifcsa:gxt Itom 360,Bias of Lading,Freight Buis and Statements of Charges and Section t(a)of Signature %rows box m �cdk<t the Contract Terms and Conditions for a list of such articles. 9 tave"e,0corw w) nlYa is crocked RECEIVED.suDed b the dassifrzliora ares ease n effect on Cie date d ria iswa of Nis Bit of t�6rg, beaten en and as to each party at any dine mores ed In au or any sold property,SO every service m be the properly described above n appamm good ardor.except as noted(mnkvas and Oorldition d car prafom*d Ile[awxw slWl tie waixt to an ha tacit of facig terms and condtlbns in Ur,governing das- tents dpackages tnknwm),markctl,cenakptod,antl desdretl as indicated above rtdtit said carrier sifiWlon on -date at shiprnera. (the word carrier biting understood throtghout Nts convect as rneanng arty person or umrpomtion in Shipper hereby canines that.he is familiar with all the lading terms and conditions in Vis poas,.sion of the propnrry under the COlilracl)apiece to carry to Its usual pleas W dehrery at said ds9i- governing classiFcabon and the said terms and conditions arc hereby agreed to by the shipper and ration,h on its route,dtfarvtse lu denier to arroihe[wrier on the mule to said dent+anon-it is mute• accepted flu htmsaff and his assigns. ally agreed as ro each caniv of all w anY d•salu property aver all w any portion W said mute U ces SHIPPER ter °'" ¢` " CARRIER PERw- - DATE - `" ,/�f-'� Permanent post-office address of shipper. ,,,�„ STYLE F360-4 02003 LABELAAS EP®(8DO)621-5808 WWW.JaWiTiaSter.COM "" SOY tNK�