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Te Zip Code State Contact Name Contact Name Phone/ Email Phone/ Email Account Number Third Party Bill To Commodity Description Zip Code City Street Address State Pieces MAWB # or Reference # Valuation Statement Notice: Unless a higher value is declared, the shipper hereby releases the property to a value of $0.50 per pound, subject to a $50.00 minimum. See below and service conditions for limitations and declared value surcharges. Gross Weight Zip Code Pieces Account No. L W H.

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