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Oate Sec Req'd: amlpm ~~ - am/pm Delivery Date Req'd: am/pm Order Taken By: _ Capitai City Transfer ~ 746~ Johnson Si. NE, Salem, OR 973~ (503) 531-5683 • (800} g2F3-1641 •~iax (503) 581-5924 Puc ~asa2 o iCC MC 227345 , :.-7 -- - / ``/`"~-<-t'- ~ ~~ HHG BILL OF LADING _ BrL Number ~ • NAME NAME ADDRESS ~ ADDRESS ~ S~ ~dn~-u SJ~°~' ~ r /~ ~ C~7y STATE ZIP CITY STATE ZIP CONTACf ~~} ' PHONE ON COUl~i'TY F,vc CONTACT PHONE ~ F,vc I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I~ ~ ~ I ~ ~ ~ I ~ ~ ~ I START TIME: INITIALS am/pm 6 AM 7 8 9 10 11 12 1 2 3 4~ 5 6 Pti1 NOON - EXPLANATION: P-PACKING L-LOADING D-DRIVING UL-UNLOADING UP-UNPACKING ~ X-TIME NOT CHARGED • FINISH TIME: INITIALS am/pm . y.~~+ALS ~IJI ~RIAI PACKtt~iCi ~I~ACKN~Ki ' J~MOUNT 1A UNITS t~T' 4'~f EXT ,, . QTY, RA7E pTY. RA"fE t~KY. FiA'i'~ . 1 TRUCK & DQ~CIER '~ f . ... „_._.~_ _ - __ - _ BARRELS/DISHPACKS . __ _ ~ _ _ _ _ ~ .. .. ~' TRUCK 8 2 ME~''1~1~ ~= ` . _.. CRATES/CONTAINERS EXTRA LABOR HOURS CARTONS: 1.5 CU FT. ~' „~,; V MATERIALS ~ 3.0 CU FT OTHER 4.5 CU FT 6.0 CU FT WARDROBE CARTON ~ ~~T~T ~! ~ MIRROR CARTON ~ ~ ' MATTRESS CTNS: SiNG~E DOUBLE OTHER OTHER: ~ A ~ ~ f su~rorn~ M . .-• . . • If the shipper declines to sign this declaration of value and the shipment is accepted, reciated value protection level and the shipper will ment will move at the de the shi c,a SugrOTA~ R • ~ ~ • DATE OF PICKUP RE~UESTED DATE OF DELIVERY REQUESTED p p b@ SUbJ@Ct t0 thB BPPfOp~l3t8 V31U8tI0f1 Ch8f98S. ^ RELEASED VALUE PROTECTION: SIGNATUREtAGREEMENT T0 HIGHER CHARGES DATE SIGNED .- ~ ~- Goods will be valued at 60 cents per Ib. per article. , GROSS WT. TARE WT. NE't' ~ WT. Shipper: Date: MILES: ~ ^ DEPRECIATED VALUE PROTECTION: Goods will be valued at $1.25 times the ._actual weight s>f the shipment. For.es~h $iQ0.04_nr fraction theraof. ~ decla~d value whichever or declared lump sum value ment in Ibs ht of the shi wei t $125 ti th . __ _ _ _e , __ ~HARGES~ FROIVf RBOVE -' _. _ _ _ . ___ _ , p . g mes e a is higher, the valuation charge shall be 50 cents per each $100.00 of value. OTHER CHARGES Shipper: Date: m m Value: L S STORAGE CHARGES p u u VALUATION CHARGES ^ REPLACEMENT COST PROTECTION: Goods will be valued at $3.50 times the actual weight of the shipment. For each $100.00, or fraction thereof, of declared value at $3.50 times the weight of the shipment in Ibs. or declared lump sum value, whichever r T(y'~'~ ~A~a~~i ~' ~ J-~~ ~/ti ~( / 7 8 is higher, the valuation charge shall be 85 cents per each $100.00 of value. qDVANCE DEPOSIT Shipper: Date: Lump Sum Value: . . a copy of the at the first contact with the carrier e received th t I ha k l d I B,Q-trA~ Du~- C.O.D. BILL PR L~7,'~~ EPAID , , v now ge a ac e form entiiled GENERAL INFORMATION FOR MOVING HOUSEHOLD GOODS OR OFFICES IN OREGON which explains the Oregon rules and regulations affecting ments of household goods and office furniture and fixtures. intrastate shi RECEIVED IN GOOD CONDITION EXCEPT AS NOTED: Consignee: p I understand that my final charge for service must be based on rates that have been approved by the Public Utility Commission and published in a tariff regardless of any Driver: estimate for service provided to me by the carrier. I UNDERSTAND THAT AN ESTIMATE IS NOT A FIRM BIQ COMMENTS/ EXCEPTIONS: Dated: Shi er: pp Carrier: VYTB NO. 50 Tl71rf1 ~nAYC