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Contractor or Carrier Household Goods Descriptive Inventory Page of Carrier s Reference No. Agent Owner s Grade or Rating and Name Contract or GBL No. Origin Loading Address City State Destination Gov t Service Order No. Van Number Descriptive Symbols CW Black White TV Owner C Color TV Professional Books PE Professional Equipment PBO Packed by Owner CD Carrier Disassembled SW Stretch Wrapped Location Symbols Exception Symbols DBO Disassembled by BE Bent SO Soiled PB P Peeling CP Carrier Packed G Gouged Chipped T Torn MCO Mechanical Condition SC Scratched Unknown MI Mildew D Dented BR Broken ST Stained R Rubbed L Loose CU Contents W Badley Worn SH Short MO Motheasten 1. Arm F Faded 15. Seat BU Burned 16. Drawer S Stretched CH 17. Door RU Rusted Veneer M Marred 12. Edge condition unknown 6. Legs 7. Rear Z Cracked 8. Right 2. Bottom 9. Side 3. Corner 10. Top 4. Front 18. Shelf 5. Left 19. Hardware 13. Center 14. Inside Note The omission of these symbols indicates good condition except for normal wear. Item Contractor No* Reference Item Remarks/Exceptions Articles Condition at Origin We have checked all the items listed and numbered 1 to inclusive and acknowledge that this is a true and complete list of the goods and services tendered and of the state of the goods received* Before signing check shipment count items and describe loss or damage in space on the right above. At Origin At Dest. Form HGI-002 Contractor carrier or authorized agent driver Signature Owner or authorized agent Shipper Ck/Dest. Arm F Faded 15. Seat BU Burned 16. Drawer S Stretched CH 17. Door RU Rusted Veneer M Marred 12. Edge condition unknown 6. Legs 7. Rear Z Cracked 8. Right 2. Bottom 9. Side 3. Corner 10. Top 4. Front 18. Shelf 5. Left 19. Hardware 13. Legs 7. Rear Z Cracked 8. Right 2. Bottom 9. Side 3. Corner 10. Top 4. Front 18. Shelf 5. Left 19. Hardware 13. Center 14. Inside Note The omission of these symbols indicates good condition except for normal wear. Center 14. Inside Note The omission of these symbols indicates good condition except for normal wear. Item Contractor No* Reference Item Remarks/Exceptions Articles Condition at Origin We have checked all the items listed and numbered 1 to inclusive and acknowledge that this is a true and complete list of the goods and services tendered and of the state of the goods received* Before signing check shipment count items and describe loss or damage in space on the right above. Item Contractor No* Reference Item Remarks/Exceptions Articles Condition at Origin We have checked all the items listed and numbered 1 to inclusive and acknowledge that this is a true and complete list of the goods and services tendered and of the state of the goods received* Before signing check shipment count items and describe loss or damage in space on the right above. At Origin At Dest. Form HGI-002 Contractor carrier or authorized agent driver Signature Owner or authorized agent Shipper Ck/Dest. Arm F Faded 15. Seat BU Burned 16. Drawer S Stretched CH 17. Door RU Rusted Veneer M Marred 12. Edge condition unknown 6. Legs 7. Rear Z Cracked 8. Right 2. Bottom 9. Side 3. Corner 10. Top 4. Front 18. Shelf 5. Left 19. Hardware 13. Center 14. Inside Note The omission of these symbols indicates good condition except for normal wear. .

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