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Date Ser. Req'd: - - am/pm Pack Date: 4;"° ~;? ~ am/pm Delivery Date Req'd• :- am/pm Order Taken By: • C~p@ta! C3#y Transfer ~ 1465 Johnson St. NE, Sa!em, OR 973~ t503) 58~-~033 ~{$Dp) 828-1641 • fax (503) 581-6924 PUC ~037342 • ICC MC 227345 J~iv,.i:~C. %.i-~~'.:;,-7 HHG BILL OF LADI~VG B/L Number 6 NAME NAME • PUB W ADDRESS ~ ADDRESS R 0 D BEST STORE CITY STATE ZIP CITY STATE Z~P E CONTACT PHONE FAX CONTACT PHO FqX I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I( ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I START TIME: INITIALS am/ m 6 AM 7 8 9 10 p 17 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: INITIALS amlpm MATEl91~ ` " MA' ~'~RIAL P~. t11+tP ACKINl~i dMQUNT • • MQNING UNITS ' RT ~T ° _... ,, t'tTY. RATE {~TY. FlAtTE 4TY. RAtE 1 TRUCK & DRIVER ° z T' _ _ _ _ . BARRELS/DISHPACKS W_ _. _ _. _ :. . _ _ TFlUCK & 2 MEN -~ _ , . __. _ . ._ .. _ ._ . _ _ CRATES/CONTAINERS EXTRA LABOR HOURS CARTONS: 1.5 CU FT. __ ~~•7 ;,~ MATERIALS ~ C~~ c, t- . ) 3.0 CU FT OTHER J' Q~ t 4S CU FT r , &0 CU FT .r .- i ~' ° t WARDROBE CARTON ' ` `" g ~~ q~„ ~ MIRROR CARTON ~ ~ . - ~ ~ - MATTRESS CTNS: SiNG~e J DOUBLE r"~ r" ~ OTHER "~ ,,J 'J7 ~ OTHER: :~ c~/~ ~./ ~ 7 `~.~ . .•, . . . IiBt OTAL'- ~ ~ . . . . A1,.:- If the shipper declines to sign this declaration of value and the shipment is accepted, the shipment will move at the depreciated value protection level and the shipper will DATE OF PICKUP REQUESTED DATE OF DELIVERY REQUESTED be subject to the appropriate valuation charges. ~RELEASED VALUE PROTECTION: S~ watUr~lnGR~uiENrTO H~e CtfinaGES , onTe Si~Ne~ , . ~ , , Goods will be valued at 60 cents per Ib. per article. ~,..,_, .~) ~ -= ,( i' ~ ~-Ct ~ ( ~) l !.C Shi A ! ; D GROSS WT. Tt~iE WT. NEf. MM. ,. pper: 1 ~~ r . ate: , MILES: ~ ^ DEPRECIATED VALUE PROTECTION: Goods will be valued at $1.25 times the l i we actua ght of the Shipment, For,~ach $i00.00, .Qr fractiQn thereQf,_Q} d~~lar.edyalue af$1.25 times the weight of the shipment in Ibs. or declared lump sum value, whichever _ . __ _ __ _ . _, _ _.,._ _ __. CFTARGES FRaIVI ABU/E "' _. _ _ .__ ..,.._ _ __. is higher, the valuation charge shall be 50 cents per each $100.00 of value. pTHER CHARGES Shipper: Date: Lump Sum Value: STORAGE CHARGES ^ REPLACEMENT COS O C VALUATION CHARGES T PR TE TION: Goods will be valued at $3.50 times the adual 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 i hi TQT/4~. CHARQ~S ~ ~7~J `j ` ~ l 7--~~`-~} • ~~' s gher, the valuation charge shall be 85 cents per each $100.00 of value. ADVANCE DEPOSIT Shipper: Date: Lump Sum Value: ~ ~ I acknowledge that I have received, at the first contact with the carrier, a copy of the ~~~~E ~~~~ C.O.D. BILL PRE ', ~ ~ ~ ~ ~~~'[.~ • _~ ~t PAID form entitled GENERAL INFORMATION FOR MOVING HOUSEHOLD GOODS OA OFFICES IN ORECaON which expiains 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 ! A~ Driver: - ~?'~ _.C~ }r'` estimate for service provided to me by the carrier. I UNDERSTAND THAT AN ESTIMATE IS NOT A FIRM BID. Dated: COMMENTS/EXCEPTIONS: Shipper: Carrier: WTB NO. 50