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Warehouse Record Of Receipt
WAREHOUSE RECORD OF RECEIPT
[Name of warehouse]
[address]
RECORD OF RECEIPT
Received from: [Received from].
For account of: [For account of].
Location: [Location].
THIS IS NOT A WAREHOUSE RECEIPT
Description Unit Value Quantity Total
[Description 1] [Unit Value 1] [Quantity 1] [Total 1]
[Description 2] [Unit Value 2] [Quantity 2] [Total 2]
[Description 3] [Unit Value 3] [Quantity 3] [Total 3]
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]