COD - BEAVER EXPRESS

1 THANK YOU FOR USING BEAVER EXPRESS SERVICE PLACE PRO LABEL HERE FREIGHT CHARGES: PREPAID COLLECT DATE PO NO. SHIPPER NO. SHIPPER (FROM): CONSIGNEE (TO): ADDRESS ADDRESS CITY, STATE, ZIP CITY, STATE, ZIP SHIPPER PHONE NO. CONSIGNEE PHONE NO. BILL THIRD PARTY FREIGHT CHARGES TO: COD AMOUNT NAME/COMPANY COD FEE PREPAID COLLECT IS CUSTOMER S CHECK ACCEPTABLE FOR COD? YES NO ADDRESS REMIT COD TO: CITY, STATE, ZIP ADDRESS ATTN: CITY, STATE, ZIP ROUTE HANDLING INFORMATION (SPECIAL RATES MAY APPLY) HAZMAT NOTIFICATION REDELIV ERY OVER L ENGTH INSIDE DELIVERY RESIDENTIAL DELIVERY LIFT GATE DELIVERY RECONSIGNMENT NUMBER SHIPPING UNITS HM* Kind of P ackaging, Descript ion of Articles, Special Marks and Except ions NMFC No.

2 CLASS WEIGHT(L BS) SUBJECT TO CO RRECTIONS TOTAL PIECES DECLARED VALUE $ TOTAL WEIGHT HAZARDOUS MATERIALS EMERGENCY CONTACT NUMBER: Carrier Liability: Carrier Liability may be limited to $50 or 50 cents per pound unless actual value, if greater, is declared. Shipment is received subject to the terms and conditions of the BEAV125 Rules Tariff. Shipments valued at more than $25 per pound are of extraordinary value. Carrier's maximum liability is $25 per pound per package subject to $100,000 maximum total liability per shipment. The agreed value on household goods, used machinery, or personal effects does not exceed ten cents per pound per article, unless otherwise specified.

3 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 D This is to cert ify t hat the materials names here in a re properly classified, desc ribed, packaged, marked and labeled, and in proper condition for transp ortation according to the applicable r egulations of The Department Tr ansp ortation. Shipper Signature Shipper hereby certifies that he understands that all transportation by BEAVER EXPRESS Service, LLC shall be subject to the term and conditions of the Bill of Lading contract shown in the NMFC 100 series, and the said terms and conditions are hereby agreed to by the shipper and accepted for himself and his assigns.

4 PICKUP DRIVER SIGNATURE AND CODE DATE/TIME SHIPPER S PRINTED SIGNATURE DATE/TIME SHIPPER PLEASE NOTE BEAVER EXPRESS SERVICE, LLC PO BOX 1147 WOODWARD, OK 73802-1147 (580) 256-6460 STRAIGHT BILL OF LADING ORIGINAL NOT NEGOTIABLE FREIGHT CHARGES ARE PREPAID ON THIS BILL OF LADING UNLESS MARKED COLLECT SHIPPER ACCT#