THE X. Y. RAILWAY COMPANY

Order Bill Of Lading - Original

This Company does not accept for transportation Money, Gold, Silverware, Valuable Papers or Paintings nor any articles of extraordinary value unless special arrangements are made.

Shipper's No.---------.

Agent's No. ---------.

Received, subject to the classification and tariffs in effect on the date of issue of this Original Bill of Lading, at ---------, 19-, from A. B., the property described below, in apparent good order, except as noted (contents and condition-of contents of packages unknown), marked, consigned and destined as indicated below, which the X. Y. Railway Company agrees to carry to its usual place of delivery at said destination, if on its road, otherwise to deliver to another carrier on the route to said destination. It is mutually agreed, as to each carrier of all or any of said property over all or any portion of said route to destination, and as to each party at any time interested in all or any of said property, that every service to be performed hereunder shall be subject to all the conditions, whether printed or written, herein contained (including conditions on back hereof) and which are agreed to by the shipper and accepted for himself and his assigns.

Freight transported under this bill of lading, in addition to rates named from point of origin to point of destination will be subject to such charges and entitled to such privileges as are set forth in tariffs published by the X. Y. Railway Company, or by connecting lines and lawfully on file with the Interstate Commerce Commission, relating to car service, inspection, mileage on private cars, reconsigning, storage, switching, weighing or other transit or terminal privileges or requirements, which in any way increase or decrease the value of the service to the shipper.

The surrender of this Original Order Bill of Lading properly endorsed shall be required before the delivery of the property. Inspection of property covered by this bill of lading will not be permitted unless provided by law or unless permission is endorsed on this original bill of lading or given in writing by the shipper.

The Rate of Freight from ---------to--------- is in Cents per 100 lbs.

IF Special per.........

IF Special per.........

IF..Times

1st Class

IF

1st Class

IF

2nd Class

IF 3rd Class

IF

4th Class

IF 5th Class

IF Class A

IF

Class B

IF Class C

IF Class D

IF Class E

(Mail Address - Not for purposes of Delivery.)

Consigned to order of C. D.

Destination-----------------------------, State of-----------------, County of-----------------,

Notify----------------------------------------------------------------------------------------------------,

At -------------------------------------, State of -----------------, County of -----------------,

Route ----------------------------------, Car Initial -----------------, Car No. -----------------.

Re.

packages

Description of Articles and Special Marks

Weight (Subject to Correction)

Class or Rata

Check Column

If charges are to be prepaid. write or stamp here, "To be Prepaid."

Received $ .....

to apply in prepayment of the charges on the property described hereon.

Agent or Cashier.

Per ..............

(The signature here acknowledges only the amount prepaid.)

Charges Advanced: s.............

----------------------------------------------Shipper ----------------------------------------Agent

Per---------------------------------------------Per-------------------------------------

(This Bill of Lading is to be signed by the Shipper and Agent of the X. Y. Ry. Co.)

For the conditions referred to in this bill of lading, see Sec. 3802. For the effect and validity of the covenants and conditions of a bill of lading, see note to Sec. 3802.