NORTWAY INC

NORTHWAY DELIVERY SERVICES INC STRAIGHT

11618 E. WASHINGTON BLVD, UNIT K WHITTIER CA 90606 BILL
Office: (562) 695-9550 (562)695-9554 (562) 695-9529 OF
Fax: 562-695-9552 LADING
Corina@NorthwayDS.com www.NorthwayDelivery.com (NOT NEGOTIABLE)

SHIP FROM SHIP TO:

SHIPPER (FROM) CONSIGNEE (TO)

ADDRESS ADDRESS

CITY, STATE, ZIP CITY, STATE, ZIP

COSIGNEE PHONE NO.

SHIPPER PHONE NO.

CUSTOMER ORDER NUMBER:

Handling Unit
QTY WEIGHT Description / SPECIAL INSTRUCTIONS CHARGES AMOUNT

REMIT C.O.D. TO: C.O.D. C.O.D. FEE 2% _______________________________________________

ADDRESS: AMT: $ Fee terms: Collect Prepaid Customer check acceptable
CITY STATE: ZIP:

If the shipment moves between two ports by a carrier by water, the law requires that
the bill of lading shall state whether it is carriers or shipper's weight. Note: where the
rate is dependent on value, shippers are required to state specifically in writing the
agreed or declared value of the property. The agreed or declared value of the property
is hereby specifically state by the shipper to be not exceeding.
$------------- -per___________________________
Subject to section 7 of the conditions, if this shipment is to be delivered, to he consignee without
recourse on the consignor, the consignor shall sign the following statement: The carrier shall not
make delivery of this shipment without payment or freight and all other lawful charges.
Signature of consignor. __________________________________________________________

Pick-up Drivers signature x Date: This is to certify that the above-named materials
are properly classified, described, packaged,
___________________________________________________________________________ market and labeled, and are in proper condition
Warehouse Signature x Date: for transportation according to the applicable
regulations of the Department of Transportations.
____________________________________________________________________________ Shipper agrees that property tendered is subject
to all provisions in the NORTHWAY DELIVERY
Delivery Driver Signature x Date:
SERVICES INC pricing or service guide>
Emergency Response Tel:
_________________________________________
____________________________________________________________________________
Shipper's signature
Consignee Signature x Date:
x_______________________________________-

By signing this, consignee agrees that shipment is received in full and good condition as well as to the terms below.

EXTRA CHARGES FOR: STORAGE AND CHANGE OF ADDRESS WILL APPLY. AFTER 30 DAYS ITEM(S) WIL NOT BE RETURNED TO THE SHIPPER
OR THE CONSINGNER. IF YOU ARE NOT AVIABLE TO RECEIVE YOUR DELIVERY YOU WILL BE CHARGED DOUBLE. APPOINTMENT EXTRA CHARGE.
NORTHWAY DELIVERY SERVICES INC will add additional charges for services requiring special pick-up/delivery procedures
(e.g. Oversize boxes, pick-up/delivery requiring extended travel)
NORTHWAY DELIVERY reserves the right to change rates without notice. Maximum liability for a lost or damaged packaged is $80 per carton and $1,100 per pallet. Liability
limitations will vary depending on the type of merchandise set in the forth in the terms & conditions>
If you wish to purchase insurance, declare value $______________________________________-Insurance charge paid to the driver(s)
$___________________________________
Insurance charge on declared value is $0.35 per $100 or fraction thereof. _____CASH__ __COMPANY CHECK Pick-up driver signature: ___________ _