HomeMy WebLinkAbout433829 BENKINS VAN LINES - CONTRACT - CONTRACT - 8850093ORDER FOR HILLSIDE ILLINOIS 60162 REG OFFICE
SERVICE PHONE 708-547 2000 1 t �d BAPO No
DOT#76029 VAN LINES LLC
—654 Guy 603-3�5- 5t417 ��iaQ �!�,;li
SHIP R PHONE CONSIGNEE l�•�— PHONE
976Y God 5Lr
ADDRESS AFT FLOOR ADDRESS / //// APT OOR
C41Y CITY
Ci. �A//lALS
C—OUNNLn(/,✓�„•_`, STATE ZIP s COUNTY STATE ZIP
ttr COD ❑ CPN ❑ DOD ❑ GOV SHIPPER'S CONTACT ❑ ENROUTE ❑ AT DESTINATION
'Your Rgins B Responsibilities When You Move Brochure Shipper's initial
RATINGWT &500 CU FT_ /?5OO MILES 1197
TARIFF �{/2._ PROVISO
BASE EXCESS TOTAL
CHARGERATE/CWT UNEHAUL
MIN SHIPMENT Ill ,MIN SHIPMENTCHARGE
❑ EXCLUSIVE USE OF A
❑ SPACE RESERVATION OF
❑ BULKY ARTICLE (describe)
SHIPPER REQUESTS NOTIFICATION OF ACTUAL CHARGES ❑ YES ❑ NO
CITY STATERIP
FT VEHICLE DESTINATIORDELIVERING AGENT
CU FT
PACKING DATF
AGREED PICK UP DATE
AGREED DELIVERY GAME
REOUESTED
OR PERIOD OF TIME
OR PERIOD OF TIME
QUALIFIES FOR GUARANTEED PICKUP AND DELIVERY ❑ YES ❑ NO
Per Tariff Guaranteed per them is up to $125 00 a day or 100% actual lodging costs plus
50%food expenses supported by receipts whichever is less
CUSTOMER'S DECLARATION of VALUE
THIS IS A TARIFF LEVEL OF CARRIER LIABILITY- IT IS-NQj INSURANCE
UMap wu sebd n1E AItFfM[Na leash o1JI ealnYdOP'MI.GLZ oaf shipment veil be vamMame tell yart
nomiss [QB>9L{.�$_jyO®1 of of hill n pros frede Is lost destroyed or Perfumed! while is your movers
custody your mover w n W its ryllm sine' N raper Me mole to the side. neosesery m re rem it to es some
.do. es when owns r.led by your mover or pay you ter Ina cost Will opairo or o .1. Ilia amtle W
like Nowood quaint w pay you for Me nisi of such a repepmenl Aneddriwnl chorus applies ter thus loll of
Gadfly m soot Da M]hlhdW tlrNDe ybu ®Oi web? bier AnwrvlM 4vN eI lLlvllry Nwwi pyvx
Undertln FOR ALL" WORTH 1" W post, your sdpmers ell be tremponed dazedwa stylus o rw lea thou
x5 wlD rr eS.IA.0 nlwne molt obed by I�B_RWN.vifli9hlgJ wL.Mlnimnrrt_ wlu berr is create II you won 10
decors. hgher va Ks Iw yof sMpment, Wu _ VM iirrribel That ember, of
��
RonfousofmyshlgryMb �$�tibi%•01D .�
You i nnit ateQ gsl_ert one of the blioma Oetlu gbie amounts under me FOR ALL ITS WORTH level of
liability that will apply for your shipment it you do not make a adecton the No DeduWble level will
wry)
No DeduNas, $250 Deductible(_) S500 IHduLUble '
pnmeg (lmtlap 1in
(V/awr, of FOR ALL ITS WORTH laved of IMbllliy)
11 any prides 1.1 destroyed or damages wnle m ydar mwere custody viiv mme ra uerel l hs Ilmlmd to nos some
will W Pe met destroyed or damaged elide mottl by W cents pm prune poi hmd. Trips the basic
Itwer', level ant s proidee m rw orwas M If you
Do rot sehM tors Nlamalrre Level d Joel oar sh pmweit wm be vervpptea as me FOR 4M ITS% IO Hiid
Napery she you who ba sem esM tlw rymhcapla vamatm Charge
To wifve the Fo All IIJ351grItJUnKLp(j1$jllpfy INtl to sa en the A termtlw Lave of Lleb ry you must wnm en
Me lire of the wans-Lo alma Per paint`
TM waterW wry NlpmaM Is
YQVr NUmilYP 1E 10VIREO bids I acknowiedgn Met for my shipment 1 move If ether waved the Fu All Its
Worst Iwel of I1=110 OR debased a value under Me For Al If s Want Ill of Inability whd selrwted a deducllble
hl weemorefte sN 2) recvnsi and read a copy of Me'Ywr Rights plod Re more Wiles When You Mode
becalms. feplemre anew pros.
rca+rmerosernmw) (Derr)
F](1IiAORDIWWY(UNUS lVALUEPAT1 DECJ MN ieGrgWstlea NaN hew prePVM ant raainada
copy ci tM Inventory of hems Valued in Elves M.51 OJ Per Pound Por Ar4cle Mat are inpudet errmy orpmm
and Mat I taw given a copy of this Inventory to IAh mover ...... sntahva I also .fhb .dge mill mmh's
imdlly for lossoleo dome's to wny aemb 'all l, s ... se W si Co per pound will be Ill m 31 obi per pound for
Ih pond al such lost or deprel ertWa (Need rn MUN sonde uepml not m e.0...... vau of Me
entire UrKetw rt untess I new speorimay Men ^rid arN aedm for uhrn a doom for im or damage is mobs or me
werhedhmerroy
(cess. sorese l IDelwl
CHARGES PAYABLE IN CASH, CERTIFIED CHECK, TRAVELERS CHECK, OR BANK CHECK (PER
TARIFF) PAYABLE TO BEKINS VAN LINES, MC, OR APPROVED CREDIT CARD If crodit extended
on bests or shlppero employsYaer offil promise to pay pert orell cbargee, shill ebmitNI dgoa
Nat he remains Primal aeble fM payment
O ORIGIN ❑ DESTINATION
PREPAYMENT REMI RED TO
CREDIT
INVOICE TO CORP M
ADDRESS
Cln_
CHARGES AUTHORIZED BY
0211C SAKI
PO
CITY STATE/ZIP
THE PRICE SHOWN BELOW IS BASED ON ACTUAL WEIGHT AND
SERVICES PERFORMED
TRANSPORTATION CHARGE ,�, t _
ORIGIN SERVICES '� iAa•et� /}F1.S•�
DESTINATION SERVICES
VALUATION CHARGE
INSURANCE SURCHARGE
FUEL SURCHARGE
THE CHARGES CONTAINED HEREIN ARE JUST AN ESTIMATE LLJ
THIS SHIPMENT WILL BE BILLED ACCORDING TO SCALE
WEIGHT AND IN ACCORDANCE WRH PREVAILING RATES
CONTAINED IN CARRIER'S PUBLISHED TARIFFS THE ESTIMATED AMOUNT OF THIS PRICE
IS SHOWN AT RIGHT BUT YOU WILL BE REQUIRED TO PAY CHARGES ACCORDING TO
ACTUAL WEIGHT HOWEVER THE MAXIMUM AMOUNT REQUIRED TO BE PAID ON
DELIVERY SHALL NOT BE MORE THAN THE CHARGES MULTIPLIED BY 110% PLUS
CHARGES FOR ANY ADDITIONAL SERVICES THAT YOU REQUESTED AFTER THE _
CONTRACT FOR SERVICE WAS EXECUTED THAT WERE NOT INCLUDED IN THE ESTIMATE
AND ANY CHARGES THAT APPLY TO IMPRACTICAL OPERATIONS AS DEFINED BY THE
APPLICABLE TARIFF EYCEPT THAT THE CHARGES COLLECTED AT DELIVERY FOR SUCH
OPERATIONS SHALL NOT EXCEED 15%OF ALL OTHER CHARGES DUE AT DELIVERY THE
CHARGES NOT COLLECTED AT DELIVERY WILL BE BILLED TO THE SHIPPER AND SHALL
BE DUE WITHIN THIRTY (n) DAYS FOLLOWING PRESENTATION OF THE FREIGHT BILL
To be effective this document is signed by an authorized BEKINS representative and the
shipper
REMARKS PUCE, -oA y .fan'A
Gr+ai P&+L. &A. Sdrifil Ywrlt�+.�
sH Q4�Irsd fat rAA�Jt;.�-. L� � 6o.tKfers
�ial1 perks dFses�.-.f ly �^�rr»+w11�,If�..ls.'k U&Nil It
I HAVE READ BOTH SIDES OF THIS DOCUMENT AGREE TO ITS PROVISIONS AND
ACKNOWLEDGE RECEIPT OF A COPY
X DATE
CIISiDMER I$MIPPER OF TGENn
BY //OO t t 2 t4 07
i,smwO SREPRESENI.b1E CODE Cefo
PRIVATE RELO GIVE TO CUSTOMER-CORP MAIL TO BOOKING AGENT
I IIIII'II) II I III