Form Co202/509-Fxf - Fedex Uniform Straight Bill Of Lading

1 of 1

Date

shipper’s bill of lading #

fedex freight

Oct 15, 2009

uniforM strAight bill of lADing

purchase order #

original---not negotiable

1417435

subject to the terMs AnD conDitions

1930250836

shipper #

shipper #

of the uniforM bill of lADing

*1930250836*

questions? call 1.866.393.4585

 fedex freight

A.M.

®

carrier scAc code: ___________

shipper

consignee

(from)

please provide zip codes and phone numbers.

(to)

Shipper

FXF Acct. #

Consignee

FXF Acct. #

SUSAN SIBBALD

NATIONAL TRADE SUPPLY LLC

90254479

Attn. to

Area Code phone Number

Attn. to

Area Code phone Number

360

331.7052

317

536.7445

Address

Address

1526 SHOREVIEW DRIVE

5340 S HARDING ST

Address (Store, Dept., Ste., Flr., Apt., Div.)

Address (Store, Dept., Ste., Flr., Apt., Div.)

Address

Address

City

City

FREELAND

INDIANAPOLIS

State/providence

Zip/postal Code

Country

State/providence

Zip/postal Code

Country

WA

IN

98249

US

46217-9573

US

Accessorial Charges  Liftgate  inside pickup  Limited Access

Accessorial Charges  Liftgate  inside Delivery  Limited Access

Special instructions

bill freight chArges to (if different than above):

Name

FXF Acct. #

Mailing Address

City

State

Zip/postal Code

Country

Area Code

phone Number

c.o.D.

1.

the letters “c.o.D.” must appear in box before consignee’s name above.

Freight charges are

prepAiD

unless

marked collect.

2.

C.O.D. funds to be collected as:

 Certified Funds

 Company Check

 personal Check

$ _____________________

checK box if collect



3.

C.O.D. fee to be paid by:

 Shipper

 Consignee

AMount

X

reMit c.o.D. to (if different than shipper above):

Name

Mailing Address

City

State

Zip/postal Code

Country

Country Code Area Code

phone Number

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, the property described below, in apparent good order, except as noted (contents and condition of contents of packages unknown) marked, consigned, and destined as shown

hereon, which said carrier agrees to carry to destination, if on its route, or otherwise to deliver to another carrier on the route to destination. Every service to be performed hereunder shall be subject to all the conditions not prohibited by law, whether printed

or written, herein contained, including the conditions on the back hereof, or otherwise referenced, which are hereby agreed to by the shipper and accepted for himself and his assigns.

cube

Weight in lbs.

nMfc iteM #

clAss

hM

Description of Articles, KinD of pAcKAge, speciAl MArKs AnD exceptions

hAnDling

h/u pKg.

pieces

(

)

optional

(x)

(subject to correction)

units (h/u)

tYpe

(subject to correction)

1

CTN

1

114

175

SANTA FE DEHUMIDIFIER 4021400

PO #:1417435

TOTAL WEIGHT

114

RESIDENTIAL PICKUP

totAl h/u:

H

MArK “x” or “rq” in the hM coluMn to DesignAte hAzArDous MAteriAls or reportAble quAntitY As DefineD in Dot regulAtions.

1

area code

for internAtionAl shipMents pleAse inDicAte beloW the nAMe, fAx nuMber AnD phone nuMber of the broKer.

hM eMergencY contAct phone nuMber (_______) ______________________

ArEA CODE

note (1) Where the rate and carrier’s liability for loss or damage may be dependent on value,

eei/seD number or exception ______________________________

phone # (_______) ______________________

shippers must state specifically in writing the agreed or declared value of the property as

ArEA CODE

broker name ___________________________________________ fAx # (_______) ________________________

follows: “the agreed or declared value of the property is specifically stated by the shipper to be

not exceeding________per_________.”

$1,200.00

shipment

for freight collect shipMents

note (2) liability limitation for loss or damage on this shipment shall be applicable as provided

Subject to Section 7 of conditions of applicable bill of lading. if this shipment is to be delivered to the consignee, without

by contract or in the current nMfc or this carrier’s governing tariffs. The Shipper may increase

recourse on the consignor, the consignor shall sign the following statement. The carrier may decline to make delivery of

liability coverage by checking the appropriate box and completing the required information. Selecting excess

this shipment without payment of freight and all other lawful charges.

liability coverage will result in additional charges in accordance with carrier’s FXF 100 series rules tariff.

Excess coverage is not available for NEW articles with actual, declared or released value provisions that are

specifically outlined in the NMFC. Not selecting an additional coverage option is considered to be a waiver

consignor signature ___________________________________________________________________________

of same and standard liability coverage will apply.

shipper certificAtion

 The article(s) described above are neW, with standard liability coverage of $25 per pound per

This is to certify that the above named materials are properly classified, described, packaged, marked, and labeled, and are

package or $100,000 per incident, whichever is lower. Shipper requests Excess Liability Coverage in the

amount of $_______________ per pound (not to exceed $50 per pound per package). in no event shall

in proper condition for transportation according to the applicable regulations of the Department of Transportation.

carrier’s liability for NEW articles exceed the actual value of the articles or $50 per pound per package,

whichever is less, with a maximum of $100,000 per incident.

shipper signature ______________________________________________________ Date __________________

 The article(s) described above are useD or reconDitioneD, with standard liability coverage

cArrier certificAtion

of $0.50 per pound per package or $10,000 per incident, whichever is lower. Shipper requests Excess

Carrier acknowledges receipt of packages and required placards. Carrier certifies emergency response information was

Liability Coverage in the amount of $5 per pound per package. in no event shall carrier’s liability for useD

or reconDitioneD articles exceed the actual value of the articles or $5 per pound per package,

made available and/or carrier has the DOT emergency response guidebook or equivalent document in the vehicle.

whichever is less, with a maximum of $10,000 per incident.

single shipMent

DAte

DriVer/eMploYee nuMber

piece count

trAiler #

note (3) commodities requiring special or additional care or attention in handling or stowing

Circle One

must be so marked and packaged as to ensure safe transportation with ordinary care. see sec.

2(e) of nMfc item 360.

y

N

fedex freight

CO202/509-FXF