Central Arizona Freight Inc.
P.O. BOX 1656
CHANDLER AZ85244

Phone: (602) 278-3803

Shipper No.

Phone No.

Shipper Name

Address

City

State & Zip

Purchase Order No.

Phone No.

Consignee Name On COD Shipments The Letters "COD" Must appear before the Consignee's name

Address

Destination & City

Zip (required)

Third Party Billing

Bill To:

Address:

City

State & Zip

Charges are Prepaid unless marked collect Collect

Route

Rate Quote

Trailer


Special Instructions

Mark "X" IN "HM" Column For Hazardous Materials

Emergency Response Telephone Number for all Hazardous Materials

Technical names are required for "N.O.S." and other generic descriptions for all hazardous material items


Number Shipping Units

HM

Kind of Packaging, Description of articles, special marks and exceptions

Weight (lbs) (Subject to Correction)

Class

NMFC No.

For Carrier Use Only
Rate / Extension












Total

Total

Total


COD

$ Signature:

C.O.D. Fee to be paid by:

C.O.D. Payment Method




Remit
C.O.D. to:

Name:

Address:

City:

State:

Zip:


Note(1) Liablity Limitation for loss or damage on this shipment may be applicable
Note(2) Commodities requiring special or additional care or addition in handling or stowing must be so marked and packaged as to ensure safe transportation with ordinary case. See Sec 2(a) or NMFC Item 360.
Note(3) Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or declared value of property as follows:
The agreed or declared value of the property is specifically state by the shipper to be not exceeding:

$ PER


Note(4) Subject to Section 7 of Conditions of applicable bill of lading. If this shipment is to be delivered to the consignee without recourse on the consignor, the consignor shall sign the following statement: The carrier may decline to make delivery of this shipment without payment of freight and all other lawful charges.



(Signature of Consignor - if Section 7 applies)

Received, subject to individually determined rates or contracts that have been agreed upon in writing between carrier and shipper, if applicable, otherwise to the rates, classifications and rules that have been established by the carrier and are available to the shipper upon request. The property described above, in apparent good order, except noted (contents and conditions of contents of packages unknown) marked, consigned, and destined as shown below, which said carrier agrees to carry to destination, if on its routes, or otherwise to deliver to another carrier on the route to destination. Every service to be performed hereunder shall be subject to the terms and conditions of the Uniform Bill of Lading set forth in the National Motor Freight Classification in effect on date of shipment, as well as, the conditions on the face hereof, which are hereby agreed to by the shipper and accepted for himself and his assigns.

Shipper Authorized Signature

Carrier Authorized Signature

Date

Time



SHIPPER

CARRIER

Driver #

# Pallets

# Pieces