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• This Memorandum IS an=Knowleogmtinai a Lflll or Lauvtg nos ween Isffileu alw t5 uui unyrnal Bill of Lading,nor a copy or duplicate,covering the property named herein,and is Shipper No. intended solely for filing or record. Carrier No. Page of Date (Name of carrier) (sCAC) On Coll on Delivery sh'pments,the letiefsTOD"must appear before consignee's name or as otherwise provided in Item 430,Sec.1, FROM: TO: Shipper Consignee Street Street City State Zip Code City State, Zip Code 24 hr.Emergency Contact Tel.No. Vehicle Route Number No.of Units BASIC DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES Proper Shipping Name,Hazard Class UN or NA Number,Proper Shipping Name, (Weight, Volume, (Subject to RATE (For Carrier &Container Type UN or NA Number,Packing Group er Hazard Class,Packing Group Gallons,etc.) Correction) ; Use Only) q 3 { r e i° PLACARDS TENDERED:YES D NO D REMIT Note—(1)Where the rale S dependent on value,shippers are required to state C.O.R.,SS p cape 1 hereby declare that the contents of 111'5 ADDRESS specifically in writing the agreed or declared value of the property,as follows:0Th0 consignment are fully and accurate(y agreed or declared value of the property is hereby speoNlcally staled by the shipper to described above by the proper shipping C.O.D.FEE: be exceeding - per name and are .1—god, packaged, COD Amt: $ PREPAID D ,,)not the applicable tariff provisions specify a limitation of the carriers liability absent marked and labelledrplecarded.and are COLLECT 11 $ a release or a value declaration by the shipper and the shipper des not release in at respects In proper conditlon for the carriers liability or dedas a value,the carders liability shall be limited to the eMent transport according to applicable Subject to Seedon 1 01 the caditbre,If lids shlpmm is to be doll to the TOTAL pmvidad bysuch p,ovisicna.S—NMFC Item 172. International aro national tar 61enee without raceuse on tna comdgn or,Iha consignor shag sign the CHARGES $ (3)Commodffes requiring speciaj or additional care or attention in handling or stowing regulations. 9wamman follow a order nt most be so marked and packaged as to ensure safe transportation.See Section 2 e of ghta carrier shall not make tletivery of itus Shipment without payment of FREIGHT CHARGES p g sp () IrelgM and all other lawful charges. FREIGHT PREPAID Chock box Il thong s Item Contract Bilis r Lading,Freight Bills and Statements of Charges and Section l(a)of pt when box at ere to 6c lite Contract Terms and Condabns for a list at such erodes. Signature (Flpnatereel co-clanad nightie checked ❑ mCzt RECEIVED,subject to the classifications and tadfla N effect on tie date of It*issue of this Rill or Lading, tlratbn and as to Irech party at any time irierecled in all or any said properly,that every service to be the property described above in apparent good order,except as noted(contents and codidon of con• pe mad hereunder shall be subject to all the bill of lading tens and conditions in the governing clas- tents nr pepkygos,,nluawn),mxkad.conefgnad.and dastrned as indicated eba/e wheh said Carder s!iration on the fate of shipment, (+he.woid rainier b13i.�g tnderstopd throughout this commet as meaning any person or corporation h Shipper hgraby-Eedifies;lhat hais familiar:with all.the tailing terms and.conditions In Ilia possession of the propedy under the contract)agrees to carry le Its usual place of delivery at said desli- governing classification and the said terms and conditions;are hereby agreed to by the shipper and nation,if on its route,dherwlse to deliver to another carrier on the route to said destinatlan It is multi- accepted for hlmsetl and his assigns. aly agreed as to each rarer of all or any of,said properly over all or any podfm of said route to des- SHIPPER CARRIER PER PER [u L, DATE �U Permanent post office address of shipper. w ea STYLE CF365-4 02003 LABELMASrEP O (800)821-5808 www.[aWmaster.com