Milburn Printing Bill Of Lading Form 252C Details

Do you own a business? If so, you may be familiar with the Milburn Form 875R. This form is used to report information about your company's income and expenses. Today, we're going to discuss some of the most important things you need to know about the Milburn Form 875R.

Here are some facts you may want to analyze before using the milburn form 875r.

QuestionAnswer
Form NameMilburn Form 875R
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesorder for service form movers, uniform household goods bill of lading, bill of lading moving contract, household goods bill of lading forms

Form Preview Example

 

MILBURN PRINTING 800-999-6690 www.milburnprinting.com

NO.

UNIFORM HOUSEHOLD GOODS BILL OF

 

IN CASE OF NEED: CONTACT TRAFFIC CONTROL MGR.

NO.

CONNECTING OR INTERLINING

CARRIER (IF ANY) ______________________________________________________________________

RECEIVED, subject to classifications, tariffs, rules and regulations including all terms printed or stamped hereon

SHIPPER ____________________________________________DATE ________________________

ADDRESS ____________________________________________________________________________

FLOOR ______________ELEV.____________________________TEL. __________________________

CITY ______________________________________COUNTY ____________STATE ______________ CITY ______________________________________ COUNTY ______________STATE ____________

ACTUAL PICKUP DATE

AGREED PICKUP DATE or period of time

(if applicable)

 

AGREED

DELIVERY DATE

GUARANTEED DELIVERY DATE

 

(if applicable)

 

 

 

 

(if applicable)

 

 

 

 

 

 

Daily Allowance

 

NOTIFICATION OF CHARGES

SHIPPER REQUESTS NOTIFICATION OF ACTUAL CHARGES TO

(C.O.D. SHIPPERS ONLY)

PARTY SHOWN BELOW n

NOTIFY ___________________________________________________________________

ADDRESS __________________________________TEL. __________________________

Tariff ___________________________

I waive my right to observe the re- weigh of this shipment.

_______________________________

SignatureDate

ORIGINAL

Gross

Tare

Net

Min. Wt.

REWEIGH

 

IN CASE OF DELAY, OR IF CHARGES EXCEED ESTIMATE BY MORE THAN 10%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTIFY ___________________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO

 

Transportation FR

OM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Origin/Destinatio

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS __________________________________TEL. __________________________

n Fee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Payment in Cash or Certified Check, Money Order, Traveler's Check or Cashier's Check

Fuel Surcharge

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BILLING INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Containers, Packing & Unpacking

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

 

 

 

 

Storage-In-Transit at Loca

 

 

 

 

 

 

 

 

 

 

 

 

tion___________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date In___

__________ Date Out___________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIT Pickup

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY & STATE

 

 

 

 

and Delivery

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Extra P

 

 

 

 

 

 

 

 

 

 

______

 

ATTENTION OF

 

 

 

 

ickups or Deliveries No.____________ at ________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Extra

Labor, Special Services or Waiting Time

 

Notice: Carrierʼs tariffs, by this reference, are made a part of the bill of lading and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

may be inspected at carrierʼs facility, or, on request, carrier will furnish a copy of any

Bu

lky Articles

 

 

 

 

 

 

 

 

 

 

 

 

tariff provision containing carrierʼs rates, rules or charges governing the shipment.

A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

dditional Weight Additives

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SPECIAL SERVICES

 

Advanced Ch

arges

 

 

 

 

 

 

n EXPEDITED SERVICE ORDERED BY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Shuttle Ser

vice

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SHIPPER DELIVERED ON OR BEFORE _____________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Self-Storage/Mini-Warehouse Pickups

or Deliveries

 

n SHIPMENT COMPLETELY OCCUPIED A __________ CU. FT. VEHICLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Overtime Pickups or Deliveries

 

 

 

 

 

 

 

 

n EXCLUSIVE USE OF A_____________CU. FT. VEHICLE ORDERED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

n SPACE RESERVATION

CU. FT. ORDERED

 

Other Additional Services

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

n ____________________________

n _______________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: For shipments with origin/destination in

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

such

 

property to the customer by carrier. The sale price

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AGENT AND

Agt. Code

FULL SERVICE

 

CONTAINERS & PACKING $

UNPACKING $

 

 

 

SERVICE DATA

No.

 

 

 

 

 

 

 

DATE LOADED

 

 

CUSTOM SERVICE

CONTAINERS & PACKING

UNPACKING

 

 

 

 

 

 

 

 

 

 

 

 

AT RES.)

 

 

CARTON DESCRIPTION

QUANTITY

QUANTITY

 

 

 

BY

 

 

DISH PACKS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE LOADED

 

 

CARTONS

LESS THAN 3 CFT.

 

 

 

 

TOTAL

AT WHSE.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BY

 

 

CARTONS

3 CFT.

 

 

 AND AND

 

 

 

 

 

AGENT

 

 

 

 

 

 

BOOKED

 

 

CARTONS

4.5

 

 

 

 

 

BY

 

 

 

 

 

 

 

 

 

ORIGIN

 

 

CARTONS

6

 

 

UNPACKING

PACKING

CONTAINERS

 

 

 

MATTRESS CTN., KING/QU. (EXCEEDING 54" X 75")

 

 

PACKED

 

 

CARTONS

6.5

 

 

 

 

 

BY

 

 

WARDROBE, CTN.

 

 

 

 

 

 

HAULER 1.

 

 

 

 

 

 

 

 

 

FROM

TO

 

CRIB MATTRESS CTN.

 

 

 

 

 

 

 

 

 

 

 

 

 

HAULER 2.

 

 

MATTRESS CTN., TWIN/TWIN LONG

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MATTRESS CTN., DOUBLE (NOT EXCEEDING 54" X 75")

 

 

 

 

 

FROM

TO

 

 

 

 

 

 

 

 

UNPACKING

 

 

HEAVY DUTY

 

 

 

 

 

 

BY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

 

OTHER

 

 

 

 

 

 

DELIVERED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER

 

 

 

 

 

TOTAL UNPACKING

$

 

 

 

 

 

 

 

 

 

 

THE CONSUMER MUST SELECT ONE OF THESE OPTIONS

 

 

FOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CUSTOMER’S DECLARATION of VALUE : THIS IS A TARIF

F LEVEL OF CARRIER LIABILITY - IT IS NOT INSURANCE

 

 

Minimum Weight or Volume Charge

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OPTION 1

 

- The Cost Estimate that you receive from your mover MUST INCL

UDE Full (Replacement) Value Protec

tion for the articles

 

Terms & Conditions for Payment of Total Charges

 

that are

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Charges n

Prepaid n C.O.D.n

 

of Full (Replacement) Value Protection shown below. Full (Replacement) Value Protection

is the most comp

rehensive plan available

 

 

 

 

to be paid Cash, Certified Check or Money Order

 

 

for

 

 

 

 

 

 

 

 

 

 

Maximum amount to be paid at time of delivery to obtain

 

1)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

delivery of an estimated C.O.D. shipment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BALANCE DUE (30 Working Days, Credit Extended if Requested)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Replacement) Value Protection, if you do not declare a higher replacement value on this form prior to the tim

e of shipment, the value of your

 

 

 

Prepayment Collected By

 

goods will be deemed to be

 

 

minimum valuation for the ship-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ment of $6,000. Under this

 

 

 

reflecting the cost of providing

 

 

 

BALANCE DUE Á

 

 

 

 

this full value cargo liability prote

 

 

 

 

 

 

 

 

 

 

If you wish t

 

 

 

 

 

 

 

 

 

 

 

 

default

 

 

 

 

 

 

ction for your shipment.

 

 

declare a higher value

 

 

 

 

 

 

 

 

 

 

o

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

amounts, you must indicate that va

lue here.

 

 

 

 

 

 

 

 

 

 

the valuation charge in your cost estimate.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Total VALUE of my s

 

 

 

 

 

 

 

 

 

 

_______ (to be provided by the Customer)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

hipment is: $ _____________________

 

DELIVERY ACKNOWLEDGEMENT: SHIPMENT WAS RECEIVED IN APPARENT GOOD CONDI-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dollar Estimate of the COST of your move at

Full (Replacement) Value Protectio

n: $

__________________ (to be provided by Carrier)

 

TION EXCEPT AS NOTED ON INVENTORY, AND SERVICES ORDERED WERE PERFORMED.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

shipment. (if you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

do not make a selection, the “No Deductible” level of FULL value

protection that is included in yo

ur cost estimate will apply):

SIGNED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

) initial

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

provided by Carrier)

REC'D FOR STORAGE

 

 

CONSIGNEE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(WAREHOUSE)

 

I acknowl

edge that for my sh

ipment I have

 

 

 

 

 

 

included in the

BY

 

 

 

 

 

PER

 

 

 

the “

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

broch

 

 

 

 

 

 

 

 

 

 

 

 

 

received a copy of

 

(WAREHOUSEMAN'S SIGNATURE)

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your Rights and Responsibilities When You Move

ure expl

aining these provisions.

 

 

 

Declaration of Article(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

--- OR ---

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of Extraordinary (Unusual) Value

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

additional cost beyond the base

I acknowledge that I have prepared and retained a copy of the

 

OPTION 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

. Under this option, a claim for

“Inventory of Items Valued in Excess of $100 Per Pound per Article”

 

rate; however it provides only minimal protection

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of the individual article multiplied

that are included in my shipment and that I have given a copy of this

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$6.00 (10 pounds times 60 cents).

Inventory to the mover’s representative. I also acknowledge that the

 

 

 

 

 

$ ________________ (to be provided by Carrier)

mover’s liability for loss of or damage to any article valued in excess

 

Dollar Estimate of the COST of your move under the 60 cents option:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

higher cost estimate provided (above) for

of $100 per pound will be limited to $100 per pound for each pound

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of such lost or damaged article(s) (based on actual article weight), not

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

must initial and sign on the lines below-

to exceed the declared value of the entire shipment, unless I have

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

______________ (Customer’s Initials)

specifically identified such articles for which a claim for loss or dam-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I acknowledge that for my shipment

 

 

 

 

for which I have received an estimate

age may be made on the attached inventory.

 

I have

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Move” brochure explaining these provisions.

__________________________________________________

 

Customer’s Signature X ____________________________________________Date____________________

 

CUSTOMER’S SIGNATURE)

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MILBURN PRINTING 800-999-6690 www.milburnprinting.com

FORM # 875R/Rev. 4/12

CONTRACT TERMS

Except when transportation is performed under the provisions of Item 1 tion performed by carrier in addition to all other rules, regulations, rates, and the location(s) specified by the carrier.

This contract is subject to all the rules, regulations, rates and charges lowing terms and conditions:

SECTION 1: The carrier or party in possession shall be liable for storage-in-transit EXCEPT loss, damage or delay caused by or resulting:

(a)

From an act, omission or order of shipper;

 

(b)

From defect or inherent vice of the article, including

 

 

changes therein;

 

(c) From (1) hostile or warlike action in time of peace or

 

 

ed attack (A) by any government or sovereign

 

 

or air forces; or (C) by an agent of any such

 

 

force whether in time of peace or war; (3)

 

 

hindering, combating, or defending against such

by

 

order of any government or public authority;

 

(d) From terrorist activity, including action in

regard-

 

less of any other cause or event that contributes

which

 

is unlawful under the laws of the United

conveyance

 

(including an aircraft, vessel, cab, truck,

threatening

 

to kill, injure, or continue to detain,

abstain from

 

doing any act as an explicit or implicit

any (A) bio-

 

logical agent, chemical agent, or

for mere per-

 

sonal monetary gain), with intent

to property;

 

or (5) a threat, attempt, or conspiracy

 

(e)

From delay caused by strikes,

in any such occur-

 

rence or disorder, and from

the shipment from

 

such causes, is instructed

 

(f)

From Acts of God.

 

SUBJECT, in addition to the

The carrier’s or the party’s in

(l)The lump sum value weight of the shipment, in pounds, whichever is greater, or

(2) The actual loss

the shipper has waived lump

sum value liability

pound per article.

SECTION 2. The

lack of capacity of any highway,

bridge or ferry, or

of the carrier; nor shall the car-

rier be bound to

carrier shall have the right in case of

physical necessity

tion.

SECTION 3.

 

(a) The

shipment from carrier, shall be liable, jointly

and

including, but not limited to, sums advanced

or

for such unpaid charges shall not thereby

 

been extended shall fail to pay such charges.

(b)

explosives or dangerous articles or goods..

SECTION 4.

the face hereof, or at any changed address of which

carrier

warehouse selected by it at the point of delivery or at

other

 

SECTION 5.

property fails to receive or claim it within fifteen (15) days

 

shown on face hereof, or if shipper fails or refuses to pay

 

option, either (a) upon notice in the manner authorized by

 

named by carrier, thirty (30) days notice of which sale shall

 

once a week for two consecutive weeks in a newspaper of gen-

 

as described in the bill of lading, and the names of the con-

 

applicable to shipment and toward expenses of notice, adver-

 

if any shall be paid to owner of property; PROVIDED that any

 

such notices, if, in the opinion of carrier, such action is necessary to

prevent deterioration or further deterioration.

 

SECTION 6.

or delay, must be filed in writing with carrier within nine (9) months

 

then within nine (9) months after a reasonable time for delivery has

 

from the date when notice in writing is given by carrier to the claimant

 

. Where a claim is not filed or suit is not instituted thereon in accordance

 

be paid.

DS-213L Rev. 4/12