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<br /> OO Copyright 2007 J.J.KELLER&ASSOCIATES,INC.,Neenah,WI•USA•(800)327-6868•www.jjkeller.com•Printed in the UnitAd States
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<br /> TH IS M EMORAN DU M �s an acknowledgement that a bitl of latlinq has been issued and is not ihe Original BIII of Latling,not a copy p
<br /> or duplicate,covering the pmperty named herein,antl is intentled solery for filing or recortl.
<br /> Shipper's No.
<br /> Carrier '��"�`����������''�`��'�-& ~�<����'�� SCAC Carrier's No. �����
<br /> RECEIVED,subject to individually determined rates or contracts that have been agreed upon in writing between the carrier and shipper,if applicable,othenvise to the rates,classifications and ruies that have been
<br /> established by the carrier and are available to the shipper,on request;and all applicabie state and federal rggulatio�. f
<br /> at �..���w��t��fi'�, �s� , date ��'' � �� from '
<br /> the Property tlescribed below,in apparent gootl ortler,exce0�as notetl(conlents antl contlinon of coments of packages unknown),marketl.consigned and destined as intlicatetl below whlch saitl company(Ihe word company being untlers�ootl ihroughout chis
<br /> coniract as meaning any person or corpoiat�ion in possession of t�e property untler the contrac�)agrees to carry�o tlelivery at saitl tleslination,il on its route,or otherwise to tleliver to another carrier on lhe roule ro said tlestination.It is mutually agreed as to each �
<br /> carrier of all or any ot saitl Property over all or any portion ot saitl route Io destination antl as to each parry at any time interestetl in all or any of saitl Properry that every service to be peAortnetl hereuntler shall be subjea ro ali ihe contlitions not prohlbiretl by law, �
<br /> vahefher prin�etl or wntfEn,herein ContainEtl,inClutling the Contlition5 on lhe baCk hereof.whlch are hereby a9reetl t0 by the S�ippef and aCCepietl lor himsel(entl hiS ZSSigns.
<br /> !�C7�. �('_ [� � � � t �''•�,i� �li„f�� '�.
<br /> Co�nsignee ��i�����:�t��E'!4'��l��`;%..�.�.o���s,���`:, SROMr 4�_- } � ,... a � ,� �,� # ;`
<br /> Street ����`��.°�. �.�. Street �� f �a -�-:-',,"_?1�ca 1 �" ���,�„ �u'
<br /> Destination �;�,��,��$������¢�'�'�,�� Zip ����� Origin �:,J;�;4 `�°C, 1^r1 �'�` Zip
<br /> Route
<br /> peliverina Ca~rier v���"° �
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<br /> ♦ ♦ Subject�o Section 7 of conditions,if Ihis COD FEE.
<br /> RP.CT�IL COD lO. shipment is to be delivered to ihe consi9nee �OD AMT:
<br /> A,.1,.1 without reCourSB on the ConsiynOf, ihe
<br /> UUreSS. consignorshallsignthefollowingstatemeM: P(2 aid ❑
<br /> ♦ The carrier shall noi make tlelivery of this rh p
<br /> Clly. StGZtP.. ZIP. shipment without payment of freight antl all �y �
<br /> otherlawfulcharges. C���QCt �
<br /> NOTE:Where the rate is dependent on value,shippers are required to state specifically in writing TOTAL CHARGES: FREIGHT CHARGES'
<br /> the agreed or declared value of the property.The agreed or declared value of the property is •
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<br /> hereby specifically stated by the shipper to be not exceeding $ Per .:��.�,->���s or Co�s�g�o�) __——__.._ ❑ Pfepaid ❑C0110Ct
<br /> ee49US0.
<br /> NOTE Liability LimitaLon for loss or damage m this shipmeM may be applicable S • � •r
<br /> 14706(c)(1)(A)and(B). . ,� j � .. � �BY SHIPPER ��BY CARRIER
<br /> T �ci i� a �+� � � 5 '�ec� k�ge n �.. '� {"�
<br /> . . �c . . -- __oF,ic�b� ag�ile.� s o 'he P � ! `� � � DRIVER�S ��. ?�,�,f � ��,,�i
<br /> D_�� t � ..., i -. .., � SIGNATURE '+:,..�i.`• : a{ if.
<br /> SHIPPER: tf, CARRIER:, "' � �`� ``�r'-= `�
<br /> �'� � - �'�'�;� PER:� 'r' ;�k: ,� =' DATE: �'- ,�-
<br /> PE�i:-- : DATE:3^T'� .
<br /> E:.%iEKGE�I Y RCSPC��lSE ��`� �vionit�,�ed a �II ,ir*�rs the Hazardous��'ate�ia s:+�iransponaiion
<br /> 'tELEP1-IONE NUMB�: � ,�,��: `� ) "� j`� ' �;� i �nc'u�,ng s,c a�e �idental to transpertation!'i2.o04).
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