Date* 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 value greater than or equal to 0.Fuel Surcharge (In $)*Please enter a value greater than or equal to 0.Other*Please enter a value 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 value greater than or equal to 0.Fuel Surcharge (In $)*Please enter a value greater than or equal to 0.Other*Please enter a value 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 value greater than or equal to 0.Fuel Surcharge (In $)*Please enter a value greater than or equal to 0.00.Other*Please enter a value greater than or equal to 0.Total*NotesCAPTCHA
