TO: |
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SHIPPER’S # |
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P.O. # |
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CONSIGNEE |
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CoNSIGNEE PhONE # |
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CoNSIGNEE EmAIL |
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STREET |
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STREET |
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FOR PAYMENT BILL TO |
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CITY, STATE, ZIP |
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FROM: |
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SPECIAL INSTRUCTIONS |
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SHIPPER |
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STREET |
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Hazardous Materials Emergency |
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STREET |
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Response Phone Number: |
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NOTE: Liability Limitation for loss or damage on this shipment may be |
CITY, STATE, ZIP |
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applicable. See 49 U.S.C. § 14706 (c)(1)(A) and (B). |
# Packages |
HM† |
Kind of Package, Description of Articles, Special Marks and Exceptions |
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*Weight (Sub. to Corr.) |
Cl. or Rate |
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Ck. Column |
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Collect On Delivery |
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$ |
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C.O.D. Amount |
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Cash or Certified Check |
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Consignee Check Accepted |
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C.O.D. fee to |
Shipper |
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be paid by |
{Consignee |
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Freight charges are PREPAID |
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unless marked collect. |
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Full Value |
WARNING: Additional and/or maximum liability limitations or other restrictions may apply. Refer to Estes Rules |
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CHECK BOX IF COLLECT |
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Coverage |
Tariff EXLA 105 for further details. |
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NOTES: 1. Commodities requiring special or additional care or attention in handling or |
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The Shipper may request Full |
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Subject to Section 7 of Conditions, if this shipment is to |
CHARGES ADVANCED |
$ |
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Value Coverage by |
indicating |
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care. See Sec. 2(e) of NMFC Item 360. 2. The fiber boxes used for this shipment conform |
be delivered to the consignee without recourse on |
the |
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stowing must be so marked and packaged as to ensure safe transportation with ordinary |
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the total amount requested here: |
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to the specifications set forth in the box maker’s certificate thereon, and all other |
consignor, the consignor shall sign the following statement: |
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Shipper hereby requests Full Value |
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The carrier shall not make delivery of the shipment without |
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requirements of Consolidated Uniform or National Motor Freight Classification. 3. If the |
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Coverage in the total amount of: |
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payment of freight and all other lawful charges. |
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Received $ |
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to apply |
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shipment moves between two ports by a carrier by water, the law requires that the Bill of |
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$_______________________________ |
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Lading state whether it is “carrier’s or shipper’s weight.” |
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in the prepayment of the charges on the |
Refer to Estes Rules Tariff EXLA 105 |
RELEASED VALUE: $________________________; See Item 350, Section 4, |
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property described hereof. |
for further details. |
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Estes Rules Tariff EXLA 105. |
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(Signature of consignor) |
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RECEIVED, subject to individually determined rates or contracts that have been agreed upon in writing between |
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carrier of all or any of said property over all or any portion of said route to destination and as to each party at |
the carrier and shipper, if applicable, otherwise the rates, classifications and rules (See Estes Rules Tariff |
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any time interested in all or any of said property, that every service to be performed thereunder shall be subject |
EXLA 105) that have been established by the carrier and are available to the shipper, on request; The property |
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to all the terms and conditions of the Uniform Bill of Lading set forth in the National Motor Freight Classification |
described above, in apparent good order, except as noted (contents and condition of contents of packages |
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100-X and successive issues. Note: It is also agreed that the carrier will not be liable for any consequential |
unknown) marked, consigned, and destined as shown above, which said carrier agrees to carry to destination, if |
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damages arising from the delay of delivery and carrier makes no guarantees concerning the delivery dates or |
on its route, otherwise to deliver to another carrier on the route to destination. It is mutually agreed, as to each |
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times (Subject to terms and conditions of any applicable Guaranteed Service agreement). |
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SHIPPER CERTIFICATION |
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CARRIER CERTIFICATION |
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Shipper certifies by its signature, its agreement to all of the foregoing terms and conditions, and further |
Carrier acknowledges receipt of packages and required placards. Carrier certifies emergency response |
certifies that the above named materials are properly classified, described, packaged, marked and labeled, |
information was made available and/or carrier has the DOT emergency response guidebook or equivalent |
and are in proper condition for transportation according to the applicable regulations of the DOT. |
document in the vehicle. |
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SHIPPER |
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Estes Express Lines-EXLA |
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AUTHORIZED SIGNATURE |
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DATE |
AUTHORIZED SIGNATURE |
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DATE |
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