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NYPSC NO. 647

COMBINED CONTRACT, ORDER, RECEIPT FORM
CIRKER'S HAYES STORAGE WAREHOUSE, Inc.
305 EAST 61ST STREET ・ New York, N.Y. 10021 ・ TE 8-5570

AM

...affiliates...
Cirker's Moving & Storage Co., Inc   
316-322 East 46th Street, N.Y.C. 10017 - MU 6-5200 

Cirker's Gramercy Storage WHSE. Co. Inc.  
316-322 East 46th Street, N.Y.C. 10017 - MU 6-5200

Cirker's Flushing Storage WHSE. CO., Inc
135-28  39th Ave, Flushing, N.Y. 11354-FL 3-3700

DATE  4/5   1968   JOB NO.   CU. FT.
NAME  Jacques Seligman Inc   PHONE NO.
FROM  5 East 57th Street    APT. NO.
TO  Whse  PHONE NO.
APT. NO.
RATES STRAIGHT TIME: 1 VAN(S) 2 MEN @  Per Hour, Plus  Hour Travel Time
RATES OVERTIME:  VAN(S)  MEN @  Per Hour, Plus  Hour Travel Time

[[4 column table]]
| MATERIAL AND PACKING | ESTIMATED | SUPPLIED | PACKED |
| Barrels |   |   |   |
| Boxes, Wood |   |   |   |
| Over 10 C. F. not over 15 C. F. |   |   |   |
| Over 15 C. F. not over 25 C. F. |   |   |   |
| Cartons 3 C. F. or less |   |   |   |
| 3 C. F. to 6 C. F. |   |   |   |
| Over 6 C. F. |   |   |   |
| S. MATT. [[checkbox]] S. BOX [[checkbox]] |   |   |   |
| D. MATT. [[checkbox]] D. BOX [[checkbox]] |   |   |   |
| WARDROBES |   |   |   |
| CRATES |   |   |   |
|   |   |   |   |
|   |   |   |   |
|   |   |   |   |
| BINS |   |   |   |
| Extra Labor Hrs. |   |   |   |
[[/table]]

SPECIAL INSTRUCTIONS
Several Shipments.

Left Terminal A.M./P.M.
On Job A.M./P.M.  (Signature)
Time Finished A.M./P.M.  (Signature)
Returned Terminal A.M./P.M.

CARTAGE @ $

STORAGE PER MO.
WAREHOUSE LABOR IN
WAREHOUSE LABOR OUT
PACKING
MATERIAL

ADVANCES
SHIPPER DECLARES VALUE OF ENTIRE SHIPMENT to be $
INSURANCE @
TOTAL 
DEPOSIT
BALANCE C. O. D.

[[note on top of form]]
for pick up of
20 Zimmer-
1 Kupfermar
2 Cartons
[[/note]]

It is agreed that this contract which includes terms and conditions printed on the reverse side hereof, shall constitute the entire agreement between the parties and no statement or promise not contained herein shall be binding or valid.

NOTICE-Unless a greater value is declared liability is limited to 30¢ per lb. of and for each article lost or damaged. 
I have read this contract and the terms and conditions on the reverse side hereof and agree to all said terms and conditions and acknowledge receipt of copy herewith.
All rates are in accordance with Metropolitan New York Movers Tariff.

TERMS: CASH. DRIVER WILL COLLECT
Signed
Permanent Address
Accepted by William J [[Casper?]] CIRKER'S HAYES STORAGE WAREHOUSE, Inc.
RECEIVED ALL ARTICLES IN GOOD CONDITION  Signed
CUSTOMER'S COPY

MILEAGE RECORD
(For driver's use only)

LEFT WHSE
RET. WHSE