Date* MM slash DD slash YYYY Completed By* PRO #:* Agent* Manifest Number* Load Gross Revenue* # of Drivers for Deviation*123Driver #1Driver Name* Truck #* Truck Settlement #1 Do Not Use Gross PayLine Haul (Line Haul * Contractor %)*Please enter a number greater than or equal to 0.Fuel Surcharge (In $)*Please enter a number greater than or equal to 0.Other*Please enter a number greater than or equal to 0.Total*NotesDriver #2Driver Name* Truck #* Truck Settlement #2 Do Not Use Gross PayLine Haul (Line Haul * Contractor %)*Please enter a number greater than or equal to 0.Fuel Surcharge (In $)*Please enter a number greater than or equal to 0.Other*Please enter a number greater than or equal to 0.Total*NotesDriver #3Driver Name* Truck #* Truck Settlement #3 Do Not Use Gross PayLine Haul (Line Haul * Contractor %)*Please enter a number greater than or equal to 0.Fuel Surcharge (In $)*Please enter a number greater than or equal to 0.00.Other*Please enter a number greater than or equal to 0.Total*NotesHiddenSection BreakCAPTCHA
