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Date Sec Req'd: am/pm Pack Date: am/pm Delivery Date Req'd: am/pm Order Taken By: Ca~i~a1 C9ty Trans~er~ 14~5 Johnson S't. NE, Sa'em, OR ~373 , (503? 581-6683 • {80Q}:$28-1641 • fax (503) 581~6924 PUC ~037342 • ICC MC 227345 f; ,'r'f ;~'"-4~.:" fO HHG BILL OF LADING B/L Number ~ ~ NAME r NAME ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP CONTACT EL~ PHONE 588-7915 FAX CONTACT PHONE y FAX 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 PM NOON EXPLANATION: P-PACKING L-LOADING D-DRIVING UL-UNLOADING UP-UNPACKING X-TIME NOT CHARGED • FINISH TIME: i-'° INITIALS am/pm ~AAT~F~~LS NIA T~RWL PACKIMti " . 1~N1l AGI~ING AMQUNT NIOYlN~i UNt'TS FR i'~ ~"1; GTY: RATf QTY. RA7'f QT1! RAT~ 1 TRUCK & DRIVER BARRELS/DISHPACKS . ~ ~ ~~ TRUCK & 2 MEN . _ . _ .._ ~ CRATES/CONTAINERS EXTRA LABOR HOURS CARTONS: 1.5 CU FT. MATERIALS 3.0 CU FT OTHER 4.5 CU FT 6.0 CU FT WARDROBE CARTON .. S~ 18T{~T q},~- MIRROR CARTON ' • ' ' • ' MATTRESS CTNS: SiNG~E DOUBLE OTHER OTHER: ;,-. <-- ._ . . . $ B7 rYCAL;1~= S . . U87bh' A1~ i~- If the shipper declines to sign this declaration of value and the shi ment is accepted, the shipment will move at the depreciated value protection level a~Ki the shipper will DATE OF PICKUP REQUESTED DATE OF DELIVERY REQUESTED be subject to the appropriate valuation charges. ^ RELEASED VALUE PROTECTION: - " S~Gw,~rupE1AGREa-Er~r to HIG-tE CHnR~ES DATE SIGNED . , . ~ , . Goods will be alued at 60 cents per Ib. per article. t' ~.. ~ ~ ~ `~ ,Y GI~SS WT: ~ R~'~wT, ` NET WT. ,€,~,y~,~_ Shipper: Date: / r' MILES: ~ ^ DEPRECIATED VALUE PROTECTION: Goods will be valued at $1.25 times the . _ actual weight of the,ship~nent. Fgr.~ach $100,QQ, or fraCtion theiflof, Qf daclared kalue. at $125 times the weight of the shipment in Ibs. or declared lump sum value, whichever CHARGES FAOIvi`A~OVE '~ ' Y~ T^ T is higher, the valuation charge shall be 50 cents per each $100.00 of value. OTHER CHAAGES Shipper: Date: Lump Sum Value: STORAGE CHARGES 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 '{'('~('AL ~HARCES ~' Q`~. 5~~~ ~ is higher, the valuation charge shall be 85 cents per each $100.00 of value. qDVANCE DEPOSIT Shipper: Date: Lump Sum Value: . a ~~..~~~ ~E ~ '' _r._ ~-, ~ ,'S ~ , '~ 5 I acknowledge thayt I have received, at the first contact with the carrier, a copy of the C.O.D. BILL PR EPAID form entitled GENE"FtAL INFORMATION FOR MOVING HOUSEF40LD GOODS QR OFFICES IN bREGON which explains the Oregon rules and regulations affecting intrastate shipments of household goods and office furniture and fixtures. RECEIVED IN GOOD CONDITION EXCEPT AS NOTED: Consignee: 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 UN ERSTAND THAT AN ESTIMATE IS NOT A FIRM BID. ed: C~ 1~ L •'t ~ t COMMENTS/ EXCEPTIONS: . '~~~~ Shipper: . ~ ~" f Carrier: WTB NO. 50 -r.-.. r.. . w .~..