Date

Bill of Lading – Short Form – Not Negotiable

Page 1 of ________

Ship From

Bill of Lading Number:______________________

Name:

Address

City/State/Zip:

SID No.:


Bar Code Space

 

Ship To
Carrier Name:_____________________________

Name:
Address:
City/State/Zip:
CID No.:

Trailer number:
Serial number(s):

Third Party Freight Charges Bill to:

SPAC:

Name:

Address:

City/State/Zip:

Pro Number:

 

Bar Code Space

 

Special Instructions:

Freight Charge Terms: (Freight charges are prepaid unless marked otherwise)

Prepaid: ____  Collect: _____  3rd Party:____

 

  (check box): Master bill of lading with attached underlying bills of lading.

Customer Order Information

Customer Order No.

No. Pack-ages

Weight

Pallet/Slip
 (circle one)

Additional Shipper Information

 

 

 

Y

N

 

 

 

 

Y

N

 

 

 

 

Y

N

 

 

 

 

Y

N

 

Grand Total

 

 

 

 

 

Carrier Information

Handling Unit

Package

 

 

 

LTL Only

Qty

Type

Qty

Type

Weight

HM

(X)

Commodity Description
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. See Section 2(e) of NMFC item 360

NMFC No.

Class

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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: “The agreed or declared value of the property is specifically stated by the shipper to be not exceeding ______________ per _________________________.

COD Amount: $______________________

Free terms: Collect _, Prepaid _, Customer check acceptable _

Note   Liability limitation for loss or damage in this shipment may be applicable. See 49 USC § 14706(c)(1)(A) and (B).

Received, subject to individually determined rates or contracts that have been agreed upon in writing between the carrier and shipper, if applicable, otherwise to the rates, classifications and rules that have been established by the carrier and are available to the shipper, on request, and to all applicable state and federal regulations.

The carrier shall not make delivery of this shipment without payment of and all other lawful charges.
Shipper Signature_________________________________________

Shipper Signature/Date

This is to certify that the above named materials are properly classified, packaged, marked and labeled, and are in proper condition for transportation according to the applicable regulations of the DOT.

Trailer Loaded:

_ By shipper

_ By driver

Freight Counted:

_ By shipper

_ By driver/pallets said to contain

_ By driver/pieces

Carrier Signature/Pickup Date

Carrier acknowledges receipt of packages and required placards. Carrier certifies emergency response information was made available and/or carrier has the DOT emergency response guidebook or equivalent documentation in the vehicle. Property described above is received in good order, except as noted.