Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or declared value of the property as follows:
The agreed or declared value of the property is specifically stated by the shipper to be not exceeding
__________________ per ___________________.
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COD Amount: $ ______________________
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NOTE Liability Limitation for loss or damage in this shipment may be applicable. See 49 U.S.C. 14706(c)(1)(A) and (B).
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RECEIVED, subject to individually determined rates or contracts that have been agreed upon in writing between the carrier and shipper, if applicable, otherwise to the rates, classifications and rules that have been established by the carrier and are available to the shipper, on request, and to all applicable state and federal regulations.
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The carrier shall not make delivery of this shipment without payment of freight and all other lawful charges.
_______________________________________
Shipper Signature
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SHIPPER SIGNATURE / DATE
This is to certify that the above named materials are properly classified, described, packaged, marked and labeled, and are in proper condition for transportation according to the applicable regulations of the United States Department of Transportation.
__________________________________________________
Signature
Date
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TRAILER LOADED
 By Shipper
By Driver
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FREIGHT COUNTED
By Shipper
By Driver
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CONTENTS: |
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CARRIER SIGNATURE / PICKUP DATE
Carrier acknowledges receipt of packages and required placards. Carrier certifies emergency response information was made available and/or carrier has the United States Department of Transportation emergency response guidebook or equivalent documentation in the vehicle. Property described above is received in good order, except as noted.
__________________________________________________
Signature
Date
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