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<br />ORIGINAL-NOT NEGOTIABLE
<br />
<br />OPan
<br />
<br />Carrier No.
<br />Date 1/Li
<br />
<br />Page
<br />
<br />(Name of carrier) (SCAC)
<br />
<br />Co Collect on Delivery shipments, the letters 'COD must appear before consignee's name or as otherwise provided In Item 430, Sect.
<br />TO: .,,,f--,:.,..),1 F:-..1 ,,,
<br />Consignee
<br />FROM:
<br />Shipper , - • ' ..
<br />Street
<br />'1::12,5 a R NAL CR \ IE
<br />Street City State Zip Code
<br />.:-.31.-CDCKTC.:'.;
<br />City State Zip Code
<br />24 hr. Emergency Contact Tel. No.
<br />Route i
<br />Vehicle
<br />Number _. .._ .
<br />No. of Units
<br />& Container Type M
<br />BASIC DESCRIPTION
<br />UN or NA Number, Proper Shipping Name, Hazard Class, Packing Group
<br />TOTAL QUANTITY
<br />(Weight, Volume,
<br />Gallons. etc.)
<br />RATE
<br />WEIGHT
<br />(Subject to
<br />Correction)
<br />CHARGES
<br />(For Carrier
<br />Use Only I ____,
<br />ei
<br />-- • 1..Ito .,411t ,k. . 1.1It I t.„, 1. .., , 4.,•;,,,..
<br />::: C.1 "..:(*.tdi'..'-fr l'yfir‘.7,-NiF 91kintiOr' '7.'1; .1:4-'i .4
<br />,.., - -
<br />leic2___ j
<br />4 L.:4..i...4-.y DlittiS binerly ordaining ktroclean03 0 P
<br />I
<br />,....r.4tt73 t_bn-osi,..qa ttcroltis : b---",lc, mrparoc% nr-.s t!..:•.'es..y. • i",..A'-'1,:..•%•:-.
<br />killtli. Kt tileily ,acnialilina mprox Ritz
<br />IN279e.Srtfurtc .4.-V.74 C.j. 6 t:(-3 )4
<br />...._„
<br />_ _ ... ....
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<br />PLACARDS TENDERED: YES I= NO CD REMIT
<br />Nolo — (1) Where the rate is dependent on value, shippers are reqiked to slate
<br />"The
<br />I hereby declare that the contents of this ADDRESS yi..,_ . specifically in writing the agreed or declared value of the property, as lOPOWS:
<br />agreed or declared value of the property Is hereby specilkally stated by the shipper to
<br />be not exceeding per
<br />consignment are fully and accurately
<br />described whose by gyg prom moping
<br />name and are classified, packaged.
<br />cop
<br />Amt: $
<br />C.OrD. FEE:
<br />PREPAID 0
<br />Where the apoilcable tariff provisions specify a limitation of the corriees liability absent rr.rk.a an, uggepaoy,lacarded, gm are q0LLECT 0 $
<br />a release era value declaration by the shipper and the shipper does not release
<br />the carriers liability or declare a value, the carries liability shah be limited to the extent
<br />provided by such provisions. See NIVIFC Item 172.
<br />transport according to applicable ,, and nation., gover.,....n, ternatior
<br />y, all respects in proper comm. for
<br />Sullied, io Section 7 of in. or.weions. if INS Shiprneril is to be delivered to tn.
<br />croio,u..k sle vne:taw.lthot,... recourse on Um consignor. the consignor shell egn the TOTAL CHARGES $
<br />Commodities requiring special or additional care or attention in handling or stowing
<br />must be so marked and packaged as to ensure safe transponation. See Section 2(e) of
<br />hem 380, Bills of Lading, Freight Ells and Statements of Charges and Section 1(a) of
<br />reggLga,,,. The carder shall not make delivery of this shipment without payment ol
<br />freight and al other lawful charges. FREIGHT CHARGES
<br />FREIGHT PREPAID Check box it deems
<br />excertmen tiox et are to ye the Contract Terms arid Conditions tore list of such articles. Signature (Signature or consignor) onto is checked minor . .... - ..
<br />RECEIVED, subiect to ffie classifications and tariffs in elect on the date of the issue of this Eel of Lading.
<br />the property descnbed above in apparent good order, except as noted (contents and condition of con-
<br />tents of packages unknown), marked consigned, and destined as indicated above which said canier
<br />(the word canter being understood througimul this contract as meaning any person or corporation in
<br />possession of the properly inder the conffiscit) agrees to carry to Its usual place of delivery at said desk-
<br />nation, don its mule, otherwise to dedWer to another earner on the route to said destination. It Is mutu-
<br />ally agreed as to each carder of all or any of, said properly over all or any portion of said route to des-
<br />,-
<br />fination and as to each party at any bine Interested in all or any said property. that every servme to
<br />be performed hereunder shall be siterd Sail the bill ol lading terms and conditions 41 the governing clas-
<br />sification on the date of shipment.
<br />Shipper hereby certifies bat he is farniliar with all the lading terms and conditions in the
<br />governing classification and the said terms and conditions are hereby agreed to by he shipper arid
<br />accepted for himself and his assigns.
<br />CARRIER SHIPPER SHIPPER
<br />PER 44
<br />DATE
<br />PER
<br />Permanent post-office address of shipper. 0 f6rgt. STYLE F370-4 C 2012 LABELASTER 0 (800) 621-5808 www.labelmaster corn
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