Date: BILL OF LADING Page 1 of ______

SHIP FROM
Name: Bill of Lading Number: ________________________
Address:
City/State/Zip: BAR CODE SPACE
SID#: FOB:
SHIP TO CARRIER NAME: _________________________________
Name: Location #: __________ Trailer number:
Address: Seal number(s):
City/State/Zip: SCAC:
CID#: FOB: Pro number:
THIRD PARTY FREIGHT CHARGES BILL TO:
Name: BAR CODE SPACE
Address:
City/State/Zip: Freight Charge Terms: ​(freight charges are prepaid unless
marked otherwise)
SPECIAL INSTRUCTIONS: Prepaid ________ Collect _______ 3​rd​ Party ______
Master Bill of Lading: with attached underlying
(check box) Bills of Lading
CUSTOMER ORDER INFORMATION
CUSTOMER ORDER NUMBER # PKGS WEIGHT PALLET/SLIP ADDITIONAL SHIPPER INFO
(CIRCLE ONE)
Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

GRAND TOTAL
CARRIER INFORMATION
HANDLING UNIT PACKAGE COMMODITY DESCRIPTION LTL ONLY
QTY TYPE QTY TYPE WEIGHT H.M. Commodities requiring special or additional care or attention in handling or stowing must be so
marked and packaged as to ensure safe transportation with ordinary care. NMFC # CLASS
(X) See Section 2(e) of NMFC Item 360

RECEIVING
STAMP SPACE

GRAND TOTAL
Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or
declared value of the property as follows:
COD Amount: $ ______________________
“The agreed or declared value of the property is specifically stated by the shipper to be not exceeding
Fee Terms: Collect: Prepaid:
__________________ per ___________________.” Customer check acceptable:
NOTE Liability Limitation for loss or damage in this shipment may be applicable. See 49 U.S.C. 14706(c)(1)(A) and (B).
RECEIVED, subject to individually determined rates or contracts that have been agreed upon in writing The carrier shall not make delivery of this shipment without payment of freight
between the carrier and shipper, if applicable, otherwise to the rates, classifications and rules that have been and all other lawful charges.
established by the carrier and are available to the shipper, on request, and to all applicable state and federal
regulations. _______________________________________​Shipper Signature
SHIPPER SIGNATURE / DATE Trailer Loaded: Freight Counted: CARRIER SIGNATURE / PICKUP DATE
​By Shipper ​
This is to certify that the above named materials are properly classified, Carrier acknowledges receipt of packages and required placards. Carrier certifies
packaged, marked and labeled, and are in proper condition for ​By Shipper emergency response information was made available and/or carrier has the DOT
transportation according to the applicable regulations of the DOT. emergency response guidebook or equivalent documentation in the vehicle.
​By Driver ​ ​By Driver/pallets said to contain Property described above is received in good order, except as noted.
​By Driver/Pieces