Shipper __________________________________________Date___________________
Received $____________to apply to prepayment of the charges on the property described hereon.
Agent or Cashier: Northland Services, Inc.
Per___________________________________________
(The signature here acknowledges only the amount prepaid.)
Shippers attention is directed to Section 18 of the Terms and Conditions. Where rate is dependent on value, shippers are required to state specifically in writing the agreed or declared vaue of the property. THE AGREED OR DECLARED VALUE OF THE PROPERTY IS HEREBY STATED BY THE SHIPPER NOT TO BE IN EXCESS OF $ PER Shipper:___________________________ Date:_________________________________
Standard tariff provisions limit Carrier's liability for household goods to $.060 per lb per item. Shipper's signature heron acknowledges this released valuation unless a different value is declared here and additional charges are paid per Tariff NOLS-100, Rule 985.THE RELEASED VALUE OF THE PROPERTY IS NOT TO EXCEED $ PER LB. PER ITEMShipper:___________________________ Date:_________________________________