WAREHOUSE RECORD OF RECEIPT
_________________________________________ (Name of
Warehouse)
_________________________________________ (Address)
RECORD OF RECEIPT
Received from: _______________________________.
For account of: _______________________________.
Location: ___________________________________.
THIS IS NOT A WAREHOUSE RECEIPT
Description Unit Value
Quantity Total
__________
_________ __________ __________
__________
_________ __________ __________
__________
_________ __________ __________
Certification and Declaration
The undersigned having all right, title, and
interest to transfer the property described below, hereby requests a
____________ (negotiable or nonnegotiable) warehouse receipt for such goods be
issued in the name of __________ and sent to ________________________ of
_______________________________ (address), ____________ (city), _____________
(county), ________________ (state).
The undersigned certifies that all quantities,
weights, measure, makes, and descriptions including but not limited to values
as stated on this document are true and correct. Liability of __________ (name
of warehouseman) shall be limited to values as stated.
_______________________________________________________________
(Signature of Storer)
Warehouse Certification
Inspection having been made, goods listed in this
record of receipt have been duly received in apparent good condition and the
declarations of quantity, weights, descriptions, and value appear to be correct
as stated by the storer. Values are
storers and warehouseman disclaims all liability and responsibility for them.
__________________________
(Warehouse Company)
_______________________
(Signature of Authorized Agent)
