Get 1799 Form

X if applicable 23. SIGNATURE DD FORM 1799 SEP 1998 PREVIOUS EDITION IS OBSOLETE. Reset Adobe Professional 7. MEMBER S REPORT ON CARRIER PERFORMANCE - MOBILE HOME 1. DATE YYYYMMDD SECTION I - TO BE COMPLETED BY DESTINATION ITO 2. REQUIRED DELIVERY DATE 3. GOVERNMENT BILL OF LADING NUMBER YYYYMMDD 4a* NAME OF MEMBER Last First Middle Initial b. GRADE 5. NAME OF CARRIER 7. PICKUP ADDRESS Street Apartment No* City State ZIP Code 6. ORIGIN INSTALLATION 8. DESTINATION INSTALLATION X if TRAILER COURT STORAGE FACILITY Complete every item applicable by placing an X in the column under YES or NO. All items marked NO will be considered as carrier deficiencies and the performance of the carrier will be evaluated for this shipment based on items listed below. A NO answer must be explained or your response CANNOT BE USED TO RATE THE CARRIER* NO YES 9. Did the carrier pick up the mobile home on the agreed date 11. Was the mobile home offered for delivery on or before the required delivery date If NO what is the estimated value of the loss and/or damage 13. Was the carrier cooperative in checking the condition of your mobile home upon delivery 15. Did you consider the carrier personnel a* Courteous b. Cooperative c* Neat in appearance 16. Were you satisfied with the carrier s services on this movement of your mobile home at a* Origin b. Destination 17. Were the Transportation Office personnel courteous and helpful to you 18. COMMENTS Briefly explain all NO answers. 19. SIGNATURE OF MEMBER 22. NAME OF DESTINATION ITO Last First Middle Initial Type or print NO RESPONSE RECEIVED FROM MEMBER 21. MEMBER S REPORT ON CARRIER PERFORMANCE - MOBILE HOME 1. DATE YYYYMMDD SECTION I - TO BE COMPLETED BY DESTINATION ITO 2. REQUIRED DELIVERY DATE 3. GOVERNMENT BILL OF LADING NUMBER YYYYMMDD 4a* NAME OF MEMBER Last First Middle Initial b. REQUIRED DELIVERY DATE 3. GOVERNMENT BILL OF LADING NUMBER YYYYMMDD 4a* NAME OF MEMBER Last First Middle Initial b. GRADE 5. NAME OF CARRIER 7. PICKUP ADDRESS Street Apartment No* City State ZIP Code 6. ORIGIN INSTALLATION 8. GRADE 5. NAME OF CARRIER 7. PICKUP ADDRESS Street Apartment No* City State ZIP Code 6. ORIGIN INSTALLATION 8. DESTINATION INSTALLATION X if TRAILER COURT STORAGE FACILITY Complete every item applicable by placing an X in the column under YES or NO. DESTINATION INSTALLATION X if TRAILER COURT STORAGE FACILITY Complete every item applicable by placing an X in the column under YES or NO. All items marked NO will be considered as carrier deficiencies and the performance of the carrier will be evaluated for this shipment based on items listed below. All items marked NO will be considered as carrier deficiencies and the performance of the carrier will be evaluated for this shipment based on items listed below. A NO answer must be explained or your response CANNOT BE USED TO RATE THE CARRIER* NO YES 9. Did the carrier pick up the mobile home on the agreed date 11. A NO answer must be explained or your response CANNOT BE USED TO RATE THE CARRIER* NO YES 9. Did the carrier pick up the mobile home on the agreed date 11. Was the mobile home offered for delivery on or before the required delivery date If NO what is the estimated value of the loss and/or damage 13..