Tracking Number:

(bar code label)

UC002010-

We Bring Solutions,

United California Freight Solutions, Inc.

12139 Los Nietos Road, Santa Fe Springs, Ca 90670 Toll 800.717.5091 Fax 562.906.1923

Sales@unitedcaliforniafreight.com

www.ucfs.us

Date

United California Freight Solutions, Inc. does not undertake transportation of any article or package of a value of more than

$ 100.00 and liability for loss or damage thereof is limited to said sum. Claims not made within 15 days after receipt

of the merchandise or of the request to pick-up merchandise shall be deemed waived.

SHIPPER'S NAME (PICK-UP FROM)

CONSIGNEE'S NAME (TO)

Special Instructions:

Appointment

Delivery

Inside

Delivery

Residential

Delivery

Set-up

Delivery

Purchase Order #

Special

Handling

Quantity

Description of

Articles, Special Marks,

Exceptions, Etc.

Item No.

Class

Weight

Pallets

Loose boxes

Total

Received

RECEIVED IN GOOD CONDITION EXCEPT AS NOTED:

Print:

Date:

Rates and charges for transportation and/or accessorial services include fees which are transmitted by the carrier to the

California Public Utilities Commission for the purpose of funding regulation of transportation companies and taxes which

are distributed to California cities in lieu of their excise or business license taxes on for-hire transportation companies.

"Freight Prepaid"

C.O.D. AMOUNT: $

RATE $

SHIPPER

CARRIER:

UCFS

AUTHORIZED SIGNATURE

UCFS AUTHORIZED DRIVER:

Date

Amount of Pieces Picked-Up