Escolar Documentos
Profissional Documentos
Cultura Documentos
TOTA
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Where the rate is dependant on value, shippers are required to state COD Amount: $_______________
specifically in writing the agreed or declared value of the property as Free Terms: Collect ___, Prepaid ___,
follows: “The agreed or declared value of the property is specifically Customer check acceptable ___
stated by the shipper to be not exceeding ______________ per _________”
Note: Liability limitation for loss or damage in this shipment may be applicable. See 49 USC ss 14706(c)
(1)(A) and (b)
Received, subject to individually determined rates or contracts that have been The carrier shall not make delivery of this
agreed upon in writing between the carrier and shipper, if applicable, otherwise shipment without payment of and all other
to the rates, classification and rules that have been established by the carrier lawful charges.
and are available to the shipper, on request, and to all applicable state and
federal regulations
Shipper Signature______________________
This is to certify that the above named Trailer loaded: Carrier acknowledges receipt of packages and
materials are properly classified, packaged, __By shipper required placards. Carrier certifies emergency
marked and labeled, and are in proper __By driver response information was made available
condition for transportation according to the Freight counted: and/or carrier has the DOT required
applicable regulations of the DOT. __By shipper emergency response guidebook or equivalent
Shipper Signature/Date __By driver/pallets documentation. Property described above is
said to contain received in good order, except as noted.
__By driver/pieces Carrier Signature/Pickup Date