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BACK- Use for reporting APPARENT LOSS OR DAMAGE
(679)
(11-35)
(Printed in U.S.A.)

RAILWAY EXPRESS AGENCY
INCORPORATED

REPORT OF SHIPMENT OFFERED FOR DELIVERY
IN APPARENT BAD ORDER

Office________________________________________Date___________________19_____

 The following described shipment was offered for delivery in APPARENT BAD ORDER 
and was *accepted by consignee.
         refused

Consignee________________________________________________________

Address__________________________________________________________

Shipper__________________________________________________________

Address___________________________________________________________

Waybill                      Date of                    Time                        AM
Number_______________________Waybill____________________Delivered___________________PM

No. Pieces                                              Declared
Description_____________________________________________Value $________________________
                 
            Note below, full description of Goods and Nature of Bad Order

________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
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________________________________________________________________________________________

Prepare this report in duplicate. If ship-
ment is accepted, give consignee original                _______________________________
report. If shipment is refused on account                       Signature of Deliveryman
of condition send original report to
shipper. In either case retain duplicate 
for office record. 
                                                         ________________________________
                                                                Signature of Consignee

NOTE: This is not a Claim 

      This is an inspection report and does not indicate claim has been entered. 
      Any claim on this shipment must be presented in writing within 9 months from date
      of delivery as per conditions of the Express Receipt- otherwise claim will be outlawed.          

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