Date



|Date |Bill of Lading – Short Form – Not Negotiable |Page 1 of 1 |

|Ship From |Carrier Name: |

|Your Company Name |Trailer number: |

|Address | |

|City, State, Zip Code | |

|Ship To |Pro Number: |

|Haldex Brake Products |Bar Code Space |

|5334 Highway 221 South | |

|Marion, NC 28752 | |

|Third Party Freight Charges Bill to |Freight Charge Terms (Freight charges are prepaid unless marked otherwise): |

| |Prepaid θ Collect θ 3rd Party ξ |

|Haldex Freight Payables |Use UPS Freight or FedEx Freight, priority service |

|10930 North Pomona Avenue | |

|Kansas City, MO 64153 | |

|Handling Unit | |LTL Only |

|Qty |Type |

|Shipper Signature/Date |Trailer Loaded: |Freight Counted: |Carrier Signature/Pickup Date |

| |θ By shipper |θ By shipper | |

|This is to certify that the above named materials |θ By driver |θ By driver/pallets said to contain |Carrier acknowledges receipt of packages and |

|are properly classified, packaged, marked, and | |θ By driver/pieces |required placards. Carrier certifies emergency |

|labeled, and are in proper condition for | | |response information was made available and/or |

|transportation according to the applicable | | |carrier has the DOT emergency response guidebook |

|regulations of the DOT. | | |or equivalent documentation in the vehicle. |

| | | |Property described above is received in good |

| | | |order, except as noted. |

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