Total Number of Packages: 21

COLLECTION: THE UNDERSIGNED CONTRACTOR OR AUTHORIZED AGENT HAS PREPARED THE ABOVE LIST OF NUMBERED ITEMS AND INDICATED THE CONDITION IN WHICH THEY WERE RECEIVED. YOUR SIGNATURE CONFIRMS YOUR AGREEMENT WITH THE LIST, ANY ALTERATIONS MUST BE NOTED ON THIS FORM IMMEDIATELY.
At origin	Contractor or Authorized agent Driver Porter
	Crew Foreman	14 Apr 2022 Date:
	Shipper	14 Apr 2022 Date:
Into Store	Checked in by	Date:

DELIVERY: ALL GOODS LISTED HAVE BEEN DELIVERED BY THE UNDERSIGNED CONTRACTOR OR THEIR AGENT AND YOU HAVE SIGNED IN AGREEMENT. ANY DISCREPANCIES MUST BE NOTED BY YOU ON THIS FORM IMMEDIATELY.
At Destination	Contractor or Authorized agent Driver Porter
	Crew Foreman:	Date:
	Shipper:	Date:
Out of Store	Checked out by	Date: