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NON-INIFGOTIABLE BILL -OF -LADING <br />BILL NO. <br />AND TRANSPORTATION AGREEMENT <br />PRINCIPAL Th (A L c I ✓ I <br />CARRIER <br />} <br />B <br />Ipg# <br />ADDRESS <br />BROKER # <br />CITY/STATE,/ZIP <br />PH. <br />TRUCK # <br />✓� <br />UNDERLYING CARRIER <br />` i of ;i <br />W { <br />TRAILER # <br />ADDRESS <br />PH. <br />SHIPPER i <br />a` - <br />RECEIVER � � 7m <br />ADDRESS <br />v r'+/ L . <br />ADdRESS <br />CITYISTPTEIZIP -�. <br />/I <br />J <br />CITYISTATE121P �( A <br />POINT OF ORIGIN <br />POINT OF DESTINATION <br />■�.c n�,■,i�e>I>•>1��� p SUPER TAG <br />❑ 1O-WHEELER ❑ TRANSFER <br />0 SUPER-1 D ❑ DBL BOTTOMS <br />❑ STRONG ARM © SEMI -BOTTOM <br />❑ 5ND DUMP <br />❑ FLAT BED <br />❑ SIDE DUMP <br />❑ MIXER <br />❑ TRUCK & PUP <br />❑ SWEEPER <br />❑ WATER TRUCK <br />❑ OTHER _ <br />❑ HOURLY ❑ TONNAGE ,''PER LOAD <br />RATE a@7 <br />TAG NO. <br />WEIGHT <br />COMMODfTY <br />LOADING <br />ARRIVE <br />DEPART <br />UNLOADING <br />ARRNE <br />DEPART <br />STANDBY <br />TIME <br />BREAKDOWN OR <br />REASON FOR DELAY <br />©� <br />►1 <br />®� <br />rFORMbwlom <br />m <br />_ <br />ACCESSORIAL OTHER <br />STARTDRIVING ' <br />®®i <br />TOTAL CiiARGES <br />SUBJECT TO TERMS AND <br />CONDITIONS ON REVERSE SIDE <br />DRIVER 51GNATURE 0AIPPERWRECEIVER (AGENT OR CEBITCR) SIGNATURE <br />w <br />