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# Model road transport contract 1#
Shipper: _ _ _ _ _ _ _ _,
Address: _ _ _ _ _ _ _ _,
Tel: _ _ _ _ _ _ _ _ _,
Contact person: _ _ _ _ _ _ _ _,
Carrier: _ _ _ _ _ _ _ _,
Address: _ _ _ _ _ _ _ _,
Tel: _ _ _ _ _ _ _ _ _,
Contact person: _ _ _ _ _ _ _ _,
Consignee: _ _ _ _ _ _ _ _,
Tel: _ _ _ _ _ _ _ _ _,
According to the relevant national transportation regulations, the following terms are reached through full consultation between both parties, and both parties shall abide by them.
Article 1 Name of goods:, specification:, quantity:, weight: kg, value: RMB.
Article 2 Place of shipment of goods: _ _ City Street No.
Location of arrival of goods: city street number.
Article 3 The date of shipment of goods is _ _ _ _ _ _ _ _ _ _ _ _ _.
Article 4 Transport quality and safety requirements: The carrier must ensure that the goods are free from loss, shortage, deterioration, pollution and damage.
Article 5 Responsibility and mode of loading and unloading of goods: The carrier shall be responsible for loading and unloading of goods, and the carrier shall complete the loading and unloading of goods at the place designated by the shipper.
Article 6 Acceptance method of the consignee: Upon the arrival of the goods, the carrier shall immediately notify the consignee, and the consignee shall designate the unloading place, conduct on-site inspection at the unloading place, and issue an acceptance certificate (in duplicate, one for the carrier and one for the shipper) on whether the goods are in good condition.
Article 7 Transportation expenses and settlement method: The transportation expenses this time are RMB yuan, and the shipper will pay RMB yuan in advance after signing this contract, and the rest expenses will be paid within 7 days after the goods arrive for unloading and the consignee confirms that the goods are in good condition.
Article 8 After the goods are consigned, if the shipper needs to change the place of arrival, the consignee or cancel the consignment, he has the right to ask the carrier to change the contents of the contract or cancel the contract, but he must inform the carrier before the goods arrive at the destination and pay the required fees to the carrier according to the regulations.
The carrier shall take good care of the goods after their arrival and before the consignee accepts them.
Article 9 Liability for breach of contract
1, the shipper failed to meet the time and requirements stipulated in the contract.
If the carrier transports the goods to the destination or consignee by mistake, it shall transport them to the destination or consignee stipulated in the contract free of charge, and shall not exceed the delivery period of the goods agreed in Article 3 of this contract. If the goods are delivered late, the carrier shall pay the shipper RMB as liquidated damages.
3. In case of loss, shortage, deterioration, pollution, damage, etc. During the transportation of the goods, the carrier shall compensate the shipper according to the actual loss of the goods (including packaging and transportation fees) and pay the shipper a penalty of RMB.
Article 10 In case of any dispute during the performance of this contract, both parties shall negotiate amicably; if negotiation fails, it shall be submitted to the court where the contract is signed for adjudication.
Article 11 This contract is made in duplicate, with each party holding one copy. This contract shall come into effect after being signed and sealed by both parties.
Shipper: (Seal) Carrier: (Seal)
Representative: (signature) Representative: (signature)
Date of signing this contract: _ _ _ _ _ _ _ _.
Signing place of the Contract:No. Road (Street), downtown area.
Road freight transport contract II
Shipper (Party A) Carrier (Party B)
Address: Address:
Legal representative:
Tel: Tel:
Party A hereby entrusts Party B to carry Party A's transportation business, and Party B has the corresponding ability to complete Party A's transportation business. According to relevant national traffic laws and regulations, Party A and Party B have reached the following agreement through full consultation on the basis of equality and voluntariness:
Article 1 The goods entrusted by Party A to Party B are _ _ _ _ _ _ _ _. Party A shall ensure that the entrusted goods do not contain any illegal articles. When the goods entrusted by Party A are inflammable, explosive, volatile, toxic and fragile, Party A shall clearly indicate them in the entrustment form.
Article 2 Place of departure and place of arrival of goods
Party B shall transport the goods from the place designated by Party A to the destination designated by Party A according to the instructions of Party A's entrustment ... If there is any change in the place of departure and destination, Party A shall notify Party B in writing before the shipment of the goods.
(See attachment for consignment note)
Article 3 Methods of Receiving and Acceptance
After the goods carried by Party B arrive at the destination and are accepted by the inspectors designated by Party A, Party B shall require the consignee to indicate the words of acceptance completion on Party A's goods acceptance form, affix the official seal of the receiving unit and sign it, and fill in the quantity and date of receipt.
Party B shall submit the above-mentioned goods receipt to Party A, and Party A shall settle the freight with Party B on the basis of the goods receipt submitted by Party B. If the goods receipt is lost, it shall be supplemented in time. Otherwise, Party A can not only refuse to pay the freight, but also demand Party B to compensate for the loss of the goods.
Article 4 Transportation expenses
1. The transportation price is calculated according to the whole vehicle. For the specific price, please refer to the annex of this contract: highway freight price list. The attachment is omitted, and it is adjusted or increased or decreased according to the actual situation in practice.
2. If the price changes within the validity period of the contract, it shall be determined by both parties through consultation.
3. All the above prices include insurance. When Party B accepts the entrustment of Party A, it shall take out insurance in time. ..
Article 5 Method of settlement
1. Party B shall submit the goods receipt to Party A according to Article 3 of this contract, and settle the freight with the original goods receipt.
2. Party B shall issue a special invoice for the transportation expenses that have been recorded in the finance to Party A one month before the settlement on the 20th of each month (for example, the transportation expenses recorded in the finance in the month of 65438+ 10 will be settled on February 20th).
Article 6 Transport Notice
Before each consignment, Party A shall notify Party B to prepare the car by telephone or fax 24 hours in advance (except in special circumstances), and Party B shall be on time as required by Party A..
Article 7 Time limit for transportation
Party A entrusts Party B to carry each batch of goods, and Party B shall arrive within the agreed time limit. The specific transportation period shall be subject to the instructions on the consignment note.
Article 8 Mode of transportation
For each batch of goods entrusted by Party A, Party B shall not transfer or distribute the goods of third parties ... The goods are not allowed to be changed midway, otherwise the carrier will be fully responsible for the losses. The mode of transportation is land transportation by car.
Article 9 Mortgage risk
1. Party B shall pay the mortgage risk to the account designated by Party A in cash. Mortgage risk, as the risk mortgage of Party A's goods loss, if Party A's goods loss or third-party claim is caused by Party B's reasons, Party A will give priority to deduct the goods loss from the mortgage risk and pay the third-party claim, and Party A will recover the insufficient part from Party B separately.
2. The mortgage risk paid by Party B to Party A is _ _ _ _ _ _ _ (RMB) mortgage risk, which shall be paid within 5 days after the signing of this contract.
3. If Party A violates this contract, resulting in damage to Party B's interests, Party B has the right to terminate this transportation contract and request Party A to return it to risk of mortgage.
4. If the cooperation is not continued after the expiration of this contract, Party A shall return the mortgage risk to Party B within 65,438+0 months; If we continue to cooperate, we will turn to mortgage risk next year.
5. After receiving the mortgage risk from Party B, Party A shall issue documents to Party B..
Article 10 Protection of Goods
1. During loading and unloading, the goods must be handled with care. It is not allowed to dump, trample or jump on the packing box, nor to sit down or put other heavy objects on the goods.
2. In the process of loading and unloading, if the goods fall, the handling personnel shall report to the relevant departments in time, and the goods management department shall re-verify the fallen goods.
The carrier must take waterproof and moisture-proof measures for the goods and take protective measures according to the actual situation of the goods.
Article 1 1 shipper's liability
1. If Party A fails to pay the transportation fee to Party B within the time limit stipulated in this contract, it shall pay the transportation fee interest loss to Party B at the bank loan interest rate for the same period.
2. If Party A violates Paragraph 4 of Article 9 of this Contract, Party A shall pay the interest loss of mortgage risk to Party B at the bank loan interest rate for the same period.
Article 12 Liability of the Carrier
1. If Party B violates the provisions of Article 6 of this contract, it shall pay liquidated damages to Party A at the rate of 10% of the total freight per vehicle.
2. If Party B transports the goods to the wrong place or passes the consignee, it shall transport the goods to the destination agreed in the contract or deliver them to the consignee free of charge. If the goods arrive late, Party B shall pay liquidated damages to Party A at 10% of the freight of the goods and bear the corresponding economic losses caused to Party A..
3. If Party B causes pollution, moisture, damaged packaging, shortage, deterioration, unnatural damage or loss of the goods during transportation, Party B shall not only compensate Party A for the actual losses, but also bear the penalty of 10% of the transportation price.
4. If Party B has a traffic accident or other work-related injury during transportation, the losses and corresponding compensation responsibilities arising therefrom shall be borne by Party B independently, which has nothing to do with Party A. ..
5. If Party B fails to deliver the goods within the time limit required by Party A's waybill during transportation, which causes the consignee to claim compensation or cause other losses, Party B shall compensate Party A for the actual losses and bear the liquidated damages of 10% of the value of the transported goods.
6. If the above-mentioned matters occur due to force majeure, Party B's responsibilities may be reduced or exempted.
Article 13 Others
1. For matters not covered in this contract, both parties shall sign a supplementary agreement through consultation, and the supplementary agreement and the annexes to this contract have the same legal effect as this contract.
2. If there is any dispute in this contract, both parties shall settle it through friendly negotiation; If negotiation fails, both parties agree that the people's court where the defendant is located shall have jurisdiction.
3. This contract is made in duplicate, with each party holding one copy.
4. This contract shall come into effect after being signed or sealed by both parties, and shall be valid for one year.
Shipper:
Carrier:
Authorized representative:
Authorized representative:
Signature/Seal:
Signature/Seal:
Signing time: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Signature time: _ _ _ _ _ _ _
# Model road transport contract 2#
Party A (i.e. the shipper): _ _ _ _ _ _ _
Party B (i.e. the carrier): _ _ _ _ _ _ _ _ _ _ _ _
Sign the terms
Through negotiation between Party A and Party B, and on the basis of abiding by the Contract Law, the following clauses are formulated for Party A to send goods from all over the country to Party B:
1. Party A voluntarily delivers the goods sent to all parts of the country to Party B for transportation;
2. When Party A delivers the goods to Party B for transportation, it shall provide all legal procedures and standardized and safe packaging of the goods, and shall not bring prohibited articles (including all kinds of inflammable and explosive articles) into the goods, otherwise all losses caused thereby shall be borne by Party A;
3. When Party A delivers the goods to Party B for transportation, it must purchase insurance on its own according to the actual value of the goods, otherwise Party B will handle the insurance purchase on its behalf; Otherwise, Party B will not take full responsibility for the damage or loss of the goods;
4. If the package of the goods is damaged or the goods are lost during transportation, a written certificate must be signed by the consignee and the delivery driver (or the agent who arrives at the goods station). If necessary, the consignee will detain the delivery vehicle or deduct the freight receivable upon arrival. If there is no signature certificate, Party B may refuse to pay compensation;
5. If the goods arrive at the place designated by Party A safely and timely, and the receivable fees such as freight are not charged, Party B may detain the goods according to the situation and handle them by itself after reaching the one-month deadline;
6. The effective inquiry date and claim period of the goods are within forty-five days from the date of shipment, and Party B may not assume any responsibilities after the expiration;
7. The transportation price and arrival time of the goods can be determined by both parties through consultation according to the actual situation. The specific quantity, amount and delivery items shall be subject to the consignment note signed by Party B after each delivery, which shall be used as the basis for actual operations such as inquiry, claim and settlement.
8. Supplementary terms: _ _ _ _ _ _ _ _ _ _.
9. This contract is made in duplicate, one for each party;
10. If there is any contract dispute, it shall be settled through negotiation according to the contract law;
1 1. This contract shall take effect immediately from the date of signing.
Signature and official seal
Legal representative of Party A
Official Seal of Party A: _ _ _ _
Legal Representative of Party B: _ _ _ _
Official Seal of Party B: _ _ _ _
_ _ _ _ _ _ _ _ _ _ _
# Model road transport contract 3#
Party A (shipper):
Party B (carrier):
Party A and Party B, in accordance with the relevant provisions of the Contract Law, entered into a contract for the carriage of goods through consultation, with the following terms:
1. The term of the contract is one year, from the date of the month to the date of the month.
2. During the above contract period, Party A entrusts Party B to transport the goods by car and road. The name, specification, model, quantity, value, freight, place of arrival, consignee and delivery period of the specific goods shall be determined by both parties, and the waybill shall be signed as an annex to this contract, which has the same legal effect as this contract.
Three. Obligations of Party A:
1. The goods shall be packed according to national standards. If there is no uniform packaging standard, the packaging shall be carried out according to the principle of ensuring the transportation of goods. If the packaging of Party A's goods does not meet the above requirements, Party B shall lodge a complaint with Party A, and if Party A does not correct it, Party B may refuse to start the shipment.
2. Pay the freight to Party B according to the standard and time agreed by both parties.
Four. Obligations of Party B:
1. According to the requirements of the waybill, transport the goods to the place designated by Party A within the specified time limit and deliver them to the consignee designated by Party A..
2. The transported goods shall be responsible for safety and ensure that there is no shortage or damage to the goods. If such problems occur, they should be liable for compensation.
Five. Transportation expenses and settlement methods:
1. The freight is calculated according to the mileage and weight of the goods actually carried by Party B, and the specific standard is implemented according to the waybill.
2. When Party B delivers the goods to the consignee, it shall ask for the receipt certificate. () As proof of completing the transportation obligation, Party B shall settle accounts with Party A with the receipt.
3. Party A shall review the receipt voucher submitted by Party B, and pay the current freight within 10 days after confirming that the voucher is true and valid, the goods arrive on time and there are no missing or damaged problems.
6. The goods delivered by Party A to Party B are important means of production for customers, and Party B should attach great importance to them to ensure that the goods arrive on time. If the arrival of the goods is delayed due to force majeure other than natural disasters, and if the customer thinks it is Party A's responsibility, Party B shall fully compensate Party A for its economic losses. If the goods cannot reach the destination on time due to force majeure such as natural disasters, Party B shall promptly notify Party A and obtain relevant certificates so that Party A can coordinate with customers.
7. If the goods are lost, short, damaged, deteriorated and polluted during transportation, Party B shall compensate Party A for the economic losses according to the following standards.
1. If the goods are lost or cannot be used normally, full compensation shall be made according to the price recorded in the waybill; If the price is not recorded on the waybill, compensation shall be made according to the ex-factory price of similar products of Party A..
2. If the goods can be used normally after repair and the customer has no objection, compensate for the repair costs (including replacement costs, labor costs and round-trip travel expenses of repair personnel, etc. ).
Eight. If the arrival of the goods is delayed due to the reasons in Article 7 of this contract, Party B shall not only bear the responsibilities in accordance with this article, but also implement the provisions in Article 6 of this contract.
Nine. Matters not covered in this contract shall be settled by both parties through consultation. If negotiation fails, it shall be handled in accordance with the provisions of the Contract Law. Any dispute shall be submitted to Beijing Arbitration Commission for arbitration in accordance with its arbitration rules.
X this contract is made in duplicate, one for each party, and shall come into force after being signed and sealed by both parties.
Party A: Party B:
Attachment: waybill number:
Date of Issue: Year Month Day Delivery Time: Year Month Day
Issuing place: provincial highway number; Place of delivery: provincial highway number.
Shipper: Carrier:
Signature of shipper and signature of carrier
Year, month, year, month, year
# Model road transport contract 4#
Shipper: (hereinafter referred to as Party A)
Carrier: (hereinafter referred to as Party B)
In accordance with the relevant national transportation regulations, this contract is hereby concluded through full consultation between both parties for mutual compliance.
Article 1 The receipt proves that
When picking up the goods, the shipper's bill of lading (or a copy of the bill of lading) and the identity card of the designated consignee should be signed. If the consignee is an enterprise company, it should also show the delivery certificate of the unit, and it must be accepted in person when picking up the goods. The carrier is not responsible for the short weight damage of the goods afterwards.
Article 2 Packaging requirements
The shipper must pack in accordance with the standards stipulated by the competent department of the state; If there is no uniform packaging standard, it shall be packaged in accordance with the principle of ensuring the safety of goods transportation, otherwise the carrier has the right to refuse to carry.
Article 3 Time limit for delivery
After the goods arrive at the destination company, the carrier calls the consignee to pick up the goods. The consignee must pick up the goods within three days. If the goods are stored for more than seven days and no one picks them up, a storage fee of 5% of the freight of the goods will be charged every day. If it is unclaimed for more than 30 days, it will be treated as ownerless. In this case, the carrier has the right to auction the goods and deduct the storage fee.
Article 4 Basic information of goods
Article 5 Transport requirements
1 Ensure the quality of goods and prevent deterioration, among which green beans are afraid of pressure.
2 Carrier loading:
Three days after the signing of the contract, the goods will be delivered and eight days will arrive;
Hengyang Zheng Da Co., Ltd. will take delivery of the goods after paying the payment with the receipt certificate;
5. In case of time breach, except for exemption conditions, all other breaches shall be compensated according to 3% of the freight;
If there is any loss of goods, compensate according to the actual loss (pay attention to the quotation).
Article 6 Division of responsibilities
The name, quantity and value of the goods recorded in the manifest shall be provided by the shipper, who shall be responsible for its authenticity. When receiving goods, the carrier only receives the goods according to the number of pieces, and does not check and count whether there is a shortage of the quantity of each piece of goods, so the carrier does not bear the economic responsibility for the quantity and completeness of the goods. If you need to confirm, please open the box in person when you deliver the goods and indicate it on the waybill.
Article 7 Prohibition or detention
If any inspection department (public security, industry and commerce, taxation and customs) has any objection to the goods during transportation, the shipper shall be responsible for handling it, provide relevant valid certificates and bear all economic losses caused to the carrier.
Article 8 Liability for violation of law
The shipper shall not lie about the name of the goods, consign the goods prohibited by the state, or carry dangerous goods, otherwise the consequences will be at his own risk.
Article 9 Rights and obligations of all parties
(1) shipper's rights and obligations
1. shipper's rights: require the carrier to transport the goods to the destination at the time and place stipulated in the contract. After the goods are consigned, the shipper needs to change the place of arrival or consignee, or cancel the consignment, and has the right to request the carrier to change the contents of the contract or terminate the contract. However, the carrier must be informed before the goods arrive at the destination, and the required fees must be paid to the carrier according to relevant regulations.
2. Shipper's obligation: Pay the freight and miscellaneous fees to the carrier as agreed. Otherwise, the carrier has the right to stop the transportation and demand the other party to pay liquidated damages. The shipper shall pack the consigned goods in accordance with the prescribed standards, abide by the relevant provisions on the transport of dangerous goods, and deliver the consigned goods in the time and quantity stipulated in the contract.
(ii) Rights and obligations of the carrier
1. carrier's rights: collect miscellaneous fees from the shipper and consignee. If the consignee fails to pay or fails to pay the agreed miscellaneous fees on time, the carrier has the right to detain the goods. If the consignee cannot be found or refuses to take delivery of the goods, the carrier shall contact the shipper in time, be responsible for keeping the goods within the prescribed time limit, and have the right to collect the storage fee. The carrier has the right to deal with the goods that cannot be delivered within the prescribed time limit in accordance with relevant regulations.
2. Carrier's obligation: deliver the goods to the designated place within the time limit stipulated in the contract, and notify the consignee of the arrival of the goods on time. Be responsible for the safety of consigned goods, and ensure that the goods are not in short supply, damaged or artificially deteriorated. Those who have the above problems shall be liable for compensation. After the goods arrive, they shall be responsible for keeping them within the prescribed time limit.
(iii) Rights and obligations of the consignee
1. consignee's rights: after the goods are delivered to the designated place, they have the right to claim the goods with certificates. When necessary, the consignee has the right to request a change of arrival or the goods arrive at the station halfway, and sign a change agreement.
2. Consignee's obligation: after receiving the delivery notice, pick up the goods on time and pay the payable expenses. For goods delivered in excess of the specified quantity, the safekeeping fee shall be paid to the carrier.
Article 10 dispute settlement
Any dispute arising from or related to this contract can be settled by both parties through friendly negotiation; If negotiation fails, both parties agree to submit the dispute to the local arbitration commission for arbitration.
Article 1 1 came into force.
1 This contract shall come into effect after being signed by authorized representatives of both parties and stamped with official seals or special seals for the contract.
After the goods are signed by the consignee, it shows that this contract has been fulfilled, and the carrier will not bear the problems of short damage of the goods after signing. (Attachment: Bill of Lading is an integral part of this contract and has the same legal effect as this contract. )
The original of this contract is in duplicate, with each party holding one copy.
Party A (official seal): _ _ _ _ Party B (official seal): _ _ _ _ _
Legal representative (signature): _ _ _ _ _ Legal representative (signature): _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
# Model road transport contract 5#
Party A (shipper):
Party B (carrier):
Party A and Party B, in accordance with the relevant provisions of the Contract Law, entered into a contract for the carriage of goods through consultation, with the following terms:
1. The term of the contract is one year, from the date of the month to the date of the month.
2. During the above contract period, Party A entrusts Party B to transport the goods by car and road. The name, specification, model, quantity, value, freight, place of arrival, consignee and delivery period of the specific goods shall be determined by both parties, and the waybill shall be signed as an annex to this contract, which has the same legal effect as this contract.
Three. Obligations of Party A:
1. The goods shall be packed according to national standards. If there is no uniform packaging standard, the packaging shall be carried out according to the principle of ensuring the transportation of goods. If the packaging of Party A's goods does not meet the above requirements, Party B shall lodge a complaint with Party A, and if Party A does not correct it, Party B may refuse to start the shipment.
2. Pay the freight to Party B according to the standard and time agreed by both parties.
Four. Obligations of Party B:
1. According to the requirements of the waybill, transport the goods to the place designated by Party A within the specified time limit and deliver them to the consignee designated by Party A..
2. The transported goods shall be responsible for safety and ensure that there is no shortage or damage to the goods. If such problems occur, they should be liable for compensation.
Five. Transportation expenses and settlement methods:
1. The freight is calculated according to the mileage and weight of the goods actually carried by Party B, and the specific standard is implemented according to the waybill.
2. When delivering the goods to the consignee, Party B shall ask for the receipt certificate as proof of completing the transportation obligation, and settle accounts with Party A on the basis of the receipt certificate.
3. Party A shall review the receipt voucher submitted by Party B, and pay the current freight within 10 days after confirming that the voucher is true and valid, the goods arrive on time and there are no missing or damaged problems.
6. The goods delivered by Party A to Party B are important means of production for customers, and Party B should attach great importance to them to ensure that the goods arrive on time. If the arrival of the goods is delayed due to force majeure other than natural disasters, and if the customer thinks it is Party A's responsibility, Party B shall fully compensate Party A for its economic losses. If the goods cannot reach the destination on time due to force majeure such as natural disasters, Party B shall promptly notify Party A and obtain relevant certificates so that Party A can coordinate with customers.
7. If the goods are lost, short, damaged, deteriorated and polluted during transportation, Party B shall compensate Party A for the economic losses according to the following standards.
1. If the goods are lost or cannot be used normally, full compensation shall be made according to the price recorded in the waybill; If the price is not recorded on the waybill, compensation shall be made according to the ex-factory price of similar products of Party A..
2. If the goods can be used normally after repair and the customer has no objection, compensate for the repair costs (including replacement costs, labor costs and round-trip travel expenses of repair personnel, etc. ).
Eight. If the arrival of the goods is delayed due to the reasons in Article 7 of this contract, Party B shall not only bear the responsibilities in accordance with this article, but also implement the provisions in Article 6 of this contract.
Nine. Matters not covered in this contract shall be settled by both parties through consultation. If negotiation fails, it shall be handled in accordance with the provisions of the Contract Law. Any dispute shall be submitted to Beijing Arbitration Commission for arbitration in accordance with its arbitration rules.
X this contract is made in duplicate, one for each party, and shall come into force after being signed and sealed by both parties.
Party A:
Party B:
Freight order number:
Release date:
Date of shipment: date of shipment.
Release location:
Provincial number. Place of delivery: Provincial Highway 1000.
Shipper:
Carrier:
Shipper signature
Carrier signature
Date, year and month
Date, year and month
##