| TO: |   |   |   |   | SHIPPER’S # |   |   |   | P.O. # |   |   |   |   | 
| CONSIGNEE |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   | CoNSIGNEE PhONE # |   |   |   | CoNSIGNEE EmAIL |   |   |   |   | 
| STREET |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
| STREET |   |   |   |   | FOR PAYMENT BILL TO |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
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| CITY, STATE, ZIP |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
| FROM: |   |   |   |   | SPECIAL INSTRUCTIONS |   |   |   |   |   |   |   |   |   |   |   |   | 
| SHIPPER |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
| STREET |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   | Hazardous Materials Emergency |   |   |   |   |   |   |   |   |   |   |   |   | 
| STREET |   |   |   |   | Response Phone Number: |   |   |   |   |   |   |   |   |   |   |   |   | 
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|   |   |   |   |   |   |   | NOTE: Liability Limitation for loss or damage on this shipment may be | 
| CITY, STATE, ZIP |   |   |   |   |   |   | applicable. See 49 U.S.C. § 14706 (c)(1)(A) and (B). | 
| # Packages | HM† | Kind of Package, Description of Articles, Special Marks and Exceptions |   |   | *Weight (Sub. to Corr.) | Cl. or Rate |   | Ck. Column |   | Collect On Delivery | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | $ |   |   |   |   |   |   | 
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|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | C.O.D. Amount | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | Cash or Certified Check | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | Consignee Check Accepted | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | C.O.D. fee to | Shipper | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | be paid by | {Consignee | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | Freight charges are PREPAID | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 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 |   | CHECK BOX IF COLLECT |   |   |   | 
| Coverage | Tariff EXLA 105 for further details. |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   | NOTES: 1. Commodities requiring special or additional care or attention in handling or |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
| The Shipper may request Full |   | Subject to Section 7 of Conditions, if this shipment is to | CHARGES ADVANCED | $ |   |   |   | 
| Value Coverage by | indicating |   | 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 |   |   |   | 
|   |   |   |   | stowing must be so marked and packaged as to ensure safe transportation with ordinary |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
| the total amount requested here: |   | to the specifications set forth in the box maker’s certificate thereon, and all other | consignor, the consignor shall sign the following statement: |   |   |   |   |   |   |   |   |   |   | 
| Shipper hereby requests Full Value |   | The carrier shall not make delivery of the shipment without |   |   |   |   |   |   |   |   |   |   | 
|   | requirements of Consolidated Uniform or National Motor Freight Classification. 3. If the |   |   |   |   |   |   |   |   |   | 
| Coverage in the total amount of: |   | payment of freight and all other lawful charges. |   |   | Received $ |   |   |   |   | to apply | 
|   | shipment moves between two ports by a carrier by water, the law requires that the Bill of |   |   |   |   |   |   | 
| $_______________________________ |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   | Lading state whether it is “carrier’s or shipper’s weight.” |   |   |   |   |   |   |   |   |   | in the prepayment of the charges on the | 
| Refer to Estes Rules Tariff EXLA 105 | RELEASED VALUE: $________________________; See Item 350, Section 4, |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   | property described hereof. | 
| for further details. |   |   | Estes Rules Tariff EXLA 105. |   |   |   |   |   |   |   |   |   | 
|   |   |   |   | (Signature of consignor) |   |   | 
| RECEIVED, subject to individually determined rates or contracts that have been agreed upon in writing between |   | 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 |   | 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 |   | 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 |   | 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 |   | 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 |   | times (Subject to terms and conditions of any applicable Guaranteed Service agreement). | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   | SHIPPER CERTIFICATION |   |   |   |   |   | CARRIER CERTIFICATION |   |   |   |   | 
| 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. |   |   |   |   |   |   |   |   |   |   |   |   | 
|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | 
| SHIPPER |   |   |   |   | Estes Express Lines-EXLA |   |   |   |   |   |   |   | 
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| AUTHORIZED SIGNATURE |   |   | DATE | AUTHORIZED SIGNATURE |   |   |   |   |   |   |   | DATE | 
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