600 Lasalle Ave. • PANAMA, IA 51562
1-800-489-2088
SHIPPER
PLEASE NOTE
➧
FREIGHT CHARGES ARE PREPAID UNLESS MARKED COLLECT
ORIGINAL - NOT NEGOTIABLE
COLLECT
Payment Method
DATE
P.O. NO.
SHIPPER CODE
Quote NO.
CONSIGNEE (TO)
SHIPPER (FROM)
STREET
STREET
CITY, STATE, ZIP/POSTAL CODE (TELEPHONE)
,
CITY, STATE/PROVINCE, ZIP/POSTAL CODE (TELEPHONE)
,
PLACE PRO LABEL HERE
BILL TO
STREET
CITY, STATE/PROVINCE, ZIP/POSTAL CODE (TELEPHONE)
,
NUMBER SHIPPING UNITS
HM
KIND OF PACKAGING, DESCRIPTION OF ARTICLES, SPECIAL MARKS AND EXCEPTIONS
NMFC NO.
CLASS OR DENSITY OF ARTICLES
WEIGHT Subject to Correction) lb.
Freight Description:
COD AMOUNT: $
COD
Fee:
❑ Prepaid
❑ Collect
❑ U.S. ❑ Canadian
NOTE: Consignee’s company check made payable to the Shipper will be accepted by Panama and forwarded to shipper unless otherwise directed to do so by the shipper.
This is to certify that the above named materials are properly classified, described, packaged, marked and labeled, and are in proper condition according to the applicable regulations of the Department of Transportation.
_______________________________________
(Signature of Consignor)
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 stated by the shipper to be not exceeding
$ per
REMIT COD TO:
ADDRESS:
CITY, STATE/PROVINCE, ZIP/POSTAL CODE
,
Subject to Section 7 of the conditions, if this shipment is to be delivered to the consignee without recourse on the consignor, the consignor shall sign the following statement: The carrier shall not make delivery of this shipment without payment of freight and all other lawful charges.
____________________________________
(Signature of Consignor)
RECEIVED, subject to the classifications and tariffs in effect on the date of the issue of this Bill of Lading, the property described above in apparent good order, except as noted (contents and condition of contents of packages unknown), marked, consigned, and destined as indicated above which said carrier (the word carrier being understood throughout this contract as meaning any person or corporation in possession of the property under the contract) agrees to carry to its usual place of delivery at said destination, if on its route, otherwise to deliver to another carrier on the route to said destination. It is mutually agreed as to each carrier of all or any of said property over all or any portion of said route to destination and as to each party at any time interested in all or any of said property, that every service to be performed hereunder shall be subject to all the bill of lading terms and conditions in the governing classification on the date of shipment. All shipments subject to Panama Rule Tariff 125.
Shipper hereby certifies that he is familiar with all the bill of lading terms and conditions in the governing classification and the said terms and conditions are hereby agreed to by the shipper and accepted for himself and his assigns.
SHIPPER
CARRIER
PANAMA TRANSFER (PANA)
PER
PER
SIGNATURE
DRIVER DATE
Panama Transfer White Copy / Shipper Yellow Copy