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Date Ser. Req'd: am/pm Pack Date: am/pm Delivery Date Req'd: _ Order Taken 8y: artUpm ' ~: ^~:,";. ~~'~ ~ ~~ HHG BILL OF LADING ~~J ~O~i(tEttNl `~i. i~~, °~Jr~.~t~, ~i ~~l ~~) 581-6683 ~(~t1~j 82FS-1641 • fax (g~-8~?A 61L Number PUG ~37".~~ ~ 1C~ ~~°'i 2~`'3~1~ . - 3546 . N~ NAME ADDRESS ADDRESS 100 Hi!'GH STREET 1 HIGH STREET cirv srare ziP cirv - srn~ rP . . .l~LfL~ ... . . . , . .~~ ~ - . ~ ~ . - ' S~Ll1 - '~ ~p~-~ ~A CONTACT PHONE CONTACf y.` PHONE SUE LAMB F„~ 373-4389 -~ FAX START TIME: I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~( ~ I ~ ~ ~ I~ ~ ~ I ~ ~ ~ I INITIALS am/pm 6 AM 7 8 9 10 11 12 1 2 3 4 5 8 PM FINISH TIME: NOON EXPLANATION: P-PACKING L-LOADING D-DRIVING UL-UNLOADING UP-UNPACKING X-TIME NOT CHARGED INITIALS am/pm • ~ e = ~ ~ ~ a~ e. °e . •"' ~' ° ,~:,e, s~.:: e a , o `° : ~`,°~ ~a^, s`§'~:-~ ~"~p ~°~ ~ " " ~;. `~~ p~ ~ w ~ ~ 'w~~~~ > ' ' ., . ~ TRUCK ` ~ ~ ~a. n>, »b~ , ~.. ~e , m ~ e .. ~,. . . _ r . ~-. - , : BA~qELS1DISHPACK~ . `' , .~- / - ` "7 ~ TRUCI( 8~ IiAEN~ CRATES/CONTAINERS EXTRA LABOR HOURS CARTONS: 1S CU FT. MATERIALS ao cu F-r ; ~. ;~ _ _ e .o~ 4.5 CU FT ^ .. l,,~.. ~7 ` 'd &0 CU FT ' .,e ~ , q • WARDROBE CAfiTON ' . .1 ~; ~~ a~, ~ ~a,m 6 ~~ n~;. e~ ~~~'e.. § MIRROR CARTOPI . • - • MATTRESS CTNS: S~tvG~E ' ~, - / g - y "7 ~' j 3 ~g ~ DOUBLE F ~, , r' ,~f5' 3~ I f1 ~~ QfHER r 2`' a~ -.~.d ~ •~'~ 6 IX~a~ .? O~THER: ~ . -~~: tj~ , s . 0 ~ . ~ ~ ~ s •-.'~i .1i7 ' e ~ ~.~7 0~~ ~ i ~ ~ ~ a' s ~ .~,E^R a....'a a'.~, .'a 's°,"~'y ;'z°~" "'4k;f"d ''~x f aa}+°„ "W~ ~ e ~ • ~ ~ If the shipper declines to sign this declaration of value and the shipment is accepted, DATE OF PICKUP REQUESTED DATE OF DELIVERY REQUESTED the shipment will move at the depreciated value protection level and the shipper will be subject to the appropriate valuation charges. d onre si~Ne~ k s °;` ~ , a ~"~`, ~ ~" ~ ~ ~, °"' Q RELEASED VALUE PROTECTION: ~ Goods will be valued at 60 cents per Ib. per article. ~ ~ t ~ ~ ,: ~~` "" F.~. Shipper: Date: MILES: ~ ^ DEPRECIATED VALUE PROTECTION: Goods will be valyed at $1.25 times the actual weight of the shipment. For each $1~~~~qr~ t~reof, of declared value CHARGES FROM-A~OVE s hi e tr,rtthetvalu~ation~ hae eh halel be~50scern~~r each Sum value, whicheveC' - g rg ~, $100.00 of value. pTHER CHARGES Shipper: f ` Date: Lump Sum Value: <' ' ;r STORAGE CHARGES ~ ~ . VALUATION CHARGES ^ REPLAEEMENT °COS'F~ PROTECTION: Goods will be valyed'~t $3.50,ti~nes the ~. ~ ~ e ; : . ~. ~ a~tual v~reight of~th~~4hipment. For each $iQUAO; 4F fraction th¢reof, cY~deE~ed value ~~~~ ~~+~~~~~ t~ c'~/ at $3.5Q timeS-the weight of the shipmerrt in Ibs. br declared Inr~ipsurri value, whichever '. ! ~~l Y! is higher, the valuation charge shall be 85 cents per each $10~.40 of value. ADVANCE DEPOSIT Shipper: ' Date'`. Lump Sum Value: 4 '°,} ~ ~' . . • ~ BAI.~N~ 1'~1~~~' . I acknowledge that I have receive e Y~fst conja w~'yt~ the carrie~ a copy of the C.O.D. BILL .._ PREPAID M form entitled GENERAL tNFQRM N FO ZMUU~I~ ~IOUSENOLD GOODS OR RECEIVED IN GOOD CONDITI~1 ~XCEPT AS NOTED: OFFICES IN OREGON which explains th ~g rWes egulations affecting intrastate shipments of household goods and office 't fixtures. Consignee: I understand that my final charge for service must on rates that have been , approved by the Public Utility Commission and pu ished in a tariff regardless of any Driver: estimate for service prrnided to me by the carrier. I UNDERSTAND THAT AN ESTIMATE COMMENTS/EXCEPTIONS: IS NOT A FIRM BID. Dated: Shipper. Carrier: WTB NO. 50 ~.-...~.. ... .~.-