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,406 - . F - 0000 0000 406- 0000 0000

SHIPPER'S NIJ.U:: AN'O />DDRESS

I Sl1lPP ER'S ACCOLNT NUMBER 1'0T ll:GOTIAaE

0 AIR WAYBILL ~ (ll<RcaiStGtWE.W t.mE) c cpeo 1. 2. a ACl 3 ol ll'isA·rv1a)till ore <i!l~l!al; artdh;we ifle&ame 1-'<lldl.y.

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CCNSIGNEE'S NAME ANO ADDRESS

I OONS~EE'S ACCOUNT t-."Ul.IBER AU.. 0000$ ... ,\.., (IC CJ.RAH! (> I)\' N<V (ll'reft Mf M $ r<(:W(ll'!(; fl(,)A{> (lA AW or~R CM~ll;fl~ Ulllf:$$

U-ECll'IC CONi'RAAV' l~UCTIC!tiS ME G:VEll HEREOl'l rN THE -9Hli'F£R, AllD SHPNlA AORiES TW.T THE

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ISSUll-.'GCARRIER'S AGE ITT NAME M'!l CITY .ALSO NOTIFY NAME A~~OADORESS (OPTIOUAl ACCOUNTING tNf:ORMA1JON)

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1\GENrS IATACOOE I ACCCUlfl NO, AIRi T OF ~PARTVRE (ADORE SS OF FIRST CARRIER! ANO f\E.QUESTe o R()IJTNQ

i=icorn\IGAHO DEST'INA'OON CURR!!NCY1=i ~1~ I ~!j~~ mecLAA;;O \'i FCfl CJ.R~e l°ECV.ReO\'eCR CUSTOM3

TO 8Y FIRST CARRIER TO r TO 1•v AJkl'CR"I' OF ll€Sl lNA llC:.'N .. , /.MOUNT OF INSURANC€ I INSURANCE • lf -!-h\P¢ f 1.:.tiull'~ illl111rt11~ ifl ~etio1d;:noe: I

0 I FLIGHT/DATE

I Ft.IGHT+'OATE v.ilh con:li!ior.(; en nwi:t::r. t.crnof, ln:lk.:ilc i'lmt:unl lo t:c

h ::uto:t in figure. h boK m~r.d :1m.i11r.t off~";l.n~r.. HANl)UNG 1Nf()HIM'fl0H

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"' RATE CUI.SS CHARGfu'19L£ RATE/c NATI.RE AND QUANTI TY OF GOODS PIECES

""" '/\'~IGHT C9,.l!lt~..!.lY WEIGHT CHARGE

TOTAi. ONCI.. OIMENSIONS OR VOLUME) "

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' pofPAIO WE!GHT CHl\RGE COLLECT / ' w -PICKUP CHARGES OTHER CHARGES ... .. ' y,\LUJ\ i lONCl<IARGE / '~ ~i!t<E DELIVERY CHARGES

b . c . TllX ~ SHI P PER"'$ R. f .C,

""'°""1"10~~0<!0lll>O'"t ~· t»!JI:

'· J. ' TOTAL o ·IHER CHARGES DUE ,_\GENr / Shipper certlRes thal tile pa11lci.tars on U'le face hereof are c ooect and tha.1 Insofar as any part or th~ ~~~~H:11:: c~~~~~t:;i~~,~~1~;~:~·p:l~~~b:aC.,~~~~~~o:!W~b~~t1~~5~ame and I & In proper

' • E~ OUE C,.\RR!ER / ~ •. ------------------------------------------------------------------SIGNA.TIJRE OF SHIPPER OR H tS A.GENT

' TOT/>J. PREPAID / ' TOTAL COLLEC T / EXECUTED ON

~ c& ~ ~ 'Clll tm>.'CY t<l'<l~!ilOll AATtS / 11,CQJ.(CTillQ(11W.UOOl()J.l(llCV __ .. __ i'Obt;.-----rnn.;i----ai ---- rPi11Ci t -·-·&iaNArURiOFisSU1NGCARR:IERORFra ... A.'GENT""-

~------ ------------- -------------------- 406- 0000 0000 FOR CARfttEJ't'S USE ONLY ' CHAA.0E$~TO£$TINAllON / ' l OTAlCOl.LreTCH.l.flGU / N0 . 3 AT' OESTUU\TION O RIGINAL FOR 1 111J.tllUCl:'f~MO!;Tnll.Xl!I~

S HIPPER

1. Consignee:
2. Port of departure:
3. Destination port:
4. Curr:
5. Declared value:
6. Customs value:
7. Shipper's name:
8. Amount of Insurance:
9. Gross wt:
10. Chargeable wt:
11. Rate:
12. Total:
13. Description & Qty of product:
14. Signature:
15. Date: