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INTERNATIONAL PARCEL SHIPPING ORDER The UPS Store CUSTOMER:(Please Print) NAME: JAIME DAVIDOVICH DATE: 1 / 4 / 10 STREET ADDRESS: 67 EAST 11ST APT NO. 219 PHONE: 917-593-2852 CITY/STATE/ZIP: NEW YORK, NY10003 DAYTIME PHONE: EMAIL:Jdavidovich1@nyc.RR.com COUNTRY OF ORIGIN: USA PARCEL SHIPPING ORDER 03169281 SENT TO:(Please Print) NAME:(CONSIGNEE)FIRO RODRIGUEZ BORNAETXEA STREET: FEDERICO BARAIBAR 12 APT NO. 4TO PISO CITY VITORIA-GASTEIZ COUNTRY: SPAIN POSTAL CODE 01003 TELEPHONE NO. (Mandatory): 945282264 CARRIER OPTION UPS [X] DHL [ ] OTHER [ ] FREIGHT SERVICE OPTIONS PORT TO PORT OCEAN [ ] AIRPORT TO AIRPORT [ ] DOOR DELIVERY [X] DOOR PICKUP [ ] IN CASE OF INABILITY TO DELIVER OR DELIVERY REFUSED ABANDONED PACKAGE (See #9 below) INITIAL RETURNED TO CUSTOMER (See #9 below) INITIAL [[?]] PAYMENT OF DUTIES, TAXES AND OTHER CHARGES CREDIT CARD NO. (signature required below) 4147 2020 4733 8536 X Visa MC AMEX DISC EXP. DATE 02/12 [[10 columns]] | Quantity | Description of Items for Shipment | Gift | Breakable Yes | Breakable No | Customer Packed Yes | Customer Packed No | Unit Weight | Unit Value | Total Value | |---|---|---|---|---|---|---|---|---|---| | 1 | Drive Disk w/Data | | | x | | x | | 100 | 100 | TOTAL WEIGHT TOTAL VALUE 100 TOTAL QUANTITY SPECIAL INSTRUCTIONS-INCLUDING APPLICABLE EXPORT CLASSIFICATION AND LICENSE/LICENSE EXCEPTION: CHARGES: FREIGHT DECLARED VALUE PKG. LABOR PKG MATERIALS PICKUP DELIVERY DOCUMENTATION FEE OTHER: SALES TAX TOTAL CHARGES: 1. Subject to the terms and conditions herein, this The UPS Store [[symbol: trademark]] center ("we" or "us") will receive and forward parcels for customer ("you"). The carrier for all parcels accepted by us shall be UPS unless otherwise noted (other____). Parcels accepted from you are subject to refusal for shipment by the carrier. You represent that your true name and address appear above. 2. We do not accept hazardous material, illegal items or articles of unusual value, including, but not limited to cash and jewelry for shipment and/or, merchandise restricted by import regulations. If you have any questions, please consult www.ups.com, and/or the appropriate carrier's rate, service guide and tariff. 3. We assume no liability for the delivery of the parcels accepted for shipment or for loss or damage by any cause to the parcels or their contents while in transit. We are not liable for he failure of the carrier to properly collect or remit funds. You further agree that you accept all risk, including but not limited to, risk of nonpayment, insufficient funds and forgery. You further agree that we will not be liable upon any such instrument. 4. we are not liable for carrier's failure to make timely delivery on delivery date specified. Any statement by us as to probably date of delivery by carrier is a statement of opinion and estimate only and is not warranted in any manner. We are not liable for any consequential, incidental, or punitive damages, or any loss or damage resulting from delays in shipping or delivery. Our responsibility for damages to items caused by improper packing by us is limited by the Declared Value and Conditions below, subject to the terms and conditions of the carrier. 5. You understand that the carrier's liability for lost or damaged parcels is limited by the provisions contained in this International Parcel Shipping Order ("IPSO") and that declared value coverage will be available only if you have complied with all Declared Value Terms and Conditions below. You agree to all terms and conditions on this IPSO whether or not Declared Value is purchased. You expressly acknowledge that the value of each parcel does not exceed the amount stated by you in the Declared Value section of this form. If no amount is specified in the Declared Valued section, you acknowledge that the value of the parcel(s) shall not exceed $100. 6. If you have a claim against the carrier or declared value coverage provider for loss or damage to your parcel, you agree to make the claim through us. You expressly agree that we have no liability if any claim is denied or paid only in part by the carrier or any other declared value provider. 7. This IPS) constitutes the entire agreement between you and us and supersedes all prior/subsequent and/or contemporaneous representations, written or oral. 8. You represent and warrant that shipment of the items(s) is in full compliance with United States and foreign import/export laws and regulations. You agree to indemnify and hold harmless this The UPS Store [[symbol: trademark]] center and Mail Boxes Etc., Inc., (the "Franchisor") from and against any and all claims, liabilities, judgments or costs arising out of or related to any acts or omissions by you that are in violation of any United States or foreign import/export law or regulation. 9. Duties, fees and taxes are assessed on all dutiable commodities that are controlled by the country of destination and are subject to change without notice. We cannot predetermine the amount of duty or tax for a given shipment. Duties, fees and taxes, as well as all other charges including, but not limited to, customs, penalties, storage costs, or other expense incurred as a result of an action by customs or failure by you or the consignee to provide proper documentation or to obtain a required license or permit, will be charged to the consignee. You, however, accept all liability for the above obligations in the event of non-payment by the consignee. Packages refused by consignee, of which for any other reason cannot be delivered, will either be abandoned or returned to you at your expense. In either event, you are liable for shipping and all other applicable charges specified above. 10. You agree that neither this The UPS Store [[symbol: trademark]] center of Franchiser are responsible for interruptions to or failures of electronic processes, including transmission of shipping order information. 11. The UPS Store centers are independently owned and operated licensed franchisees of the Franchisor. You acknowledge and agree that Franchisor is not responsible or liable for any acts or omissions of its franchisees. CUSTOMER'S SIGNATURE [[?]] DATE 1/4/10 Customer expressly authorizes this The UPS Store center to charge you for any and all of the above mentioned charges and/or penalties in the event of non-payment of the consignee, including, but not limited to additional charges to customers credit card as described in Payment of Duties, Taxes and Other Charges above. SIGN HERE X [[?]] THANK YOU STORE NUMBER: