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This Memorandum is an acknowledgment that a Bill of Lading has been issued and is not Original Shipper No . Bill of Lading, nor a copy or duplicate, covering the property named herein , and is intended soler for fllin or record . i I , . . ( � �, C i l t r = Carrier No . Page of r ` (Name of carrier) (SCAC) Date 1 G 'tet jr � On Collect on Delivery shipments, the letters -COD- must appear before consignee's name or as otherwise provided in Item 430, Sec.1 . FROM: 70 : Shipper . Consignee Street Street City State Zip Code City r State Zip Code 24 hr. Emergency Contact Tel. No. _ j Vehicle Route Number BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES No. of Units UN or NA Number, Proper Shipping Name, Hazard Class, Packing Group (weight, Volume, (Subject to RATE (For Carder & Contain er Type H M Gallons, etc.) Correction) Use Only) ( > C, i PLACARDS TENDERED : YES t1 NO D REMIT Note — (1 ) Where the rale is dependent on value, shippers are required to state I hereby declare that the contents of this C.O.D. specifically In writing the agreed or declared value of the property, as follows: "The consignment are fully and accurately ADDRESS agreed or declared value of the property is hereby specifically staled by the shipper to described above by the proper shipping C.O.D. FEE: be not exceedingper name and are classified, packaged, COD Amt: $J PREPAID ❑ (2) Where the applicable tariff provisions specify a lim9ation of the carders liability absent marked and labelledrplacarded, and are COLLECT ❑ $ a release or a value declaration by the shipper and the shipper does not release In all respects In proper condition for the carriers liability or declare a value, the carriers liability shall be limited to the extent transport according to applicable Subject to Section 7 of the conditions; it this shipment Is to w delivered to the TOTAL provided by such provisions. See NMFC Item 172. international and national governmental consignee without recourse on the consignor, the consigner Shan sign the CHARGES $ (3) Commodities requiring special or additional care or attention in handling or stowing regulations. folic he a mer sh 9 The carder shell not make delivery of this shipment without payment of FREIGHT CHARGES must so marked and packaged as to ensure safe transportation. See Section 2(e) of freight and all other lawful charges. ' item 366 0, Bills of Lading. Freight Bills and Statements of Charges and Section 1 (a) of FREdiRr PREPAID Check box charges except when box at are to be the Contract Terms and Conditions for a list of such articles. Signature Isgg ture or Consgnor) t Is Utedkked ❑ collect RECEIVED, subject to the dassfcations and tariffs in effect on the date of the issue of this BP.I of Lading, linalion and as to each parry at any time interested in all or any said property, that every service to the property described above in apparent good order, except as noted (contents and condition of con- be performed hereunder shall be subject to all the bill of lading terms and conditions in the governing das- tents of packages unknown), marked, consigned, and destined as indicated above which said carder 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 terns and conditions in the possesson 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 carder on the route to said destination. it is mutu- accepted for himself and his assigns, ally agreed as to each carrier of all or any or, said property over all or any portion of said route to des- SHIPPER CARRIER PER _ PER4 DATE Permanent post•office address of shipper. sorwxL STYLE F370.4 ® 2012 LABELMASTER 9 (800) 621 -5808 vnvw.labeimaster.com i i