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Date: BILL OF LADING Page 1 of
SHIP FROM
Name:
Address:
City/State/Zip:
SID#: 		Bill of Lading Number:
BAR CODE SPACE
FOB:
SHIP TO
Name:
Address:
City/State/Zip:
CID#:
Location #: 		CARRIER NAME:
Trailer number:
Seal number(s):
Truck #:
FOB: Pro number:
THIRD PARTY FREIGHT CHARGES BILL TO / SPECIAL INSTRUCTIONS
Name:
Address:
City/State/Zip:
BAR CODE SPACE

Freight Charge Terms: (freight charges are prepaid unless marked otherwise)
Prepaid Collect 3rd Party
CUSTOMER ORDER INFORMATION
COMMODITY DESCRIPTION# PKGSWEIGHTPALLET/SLIP
(CIRCLE ONE)		ADDITIONAL SHIPPER INFO
Y N
Y N
Y N
Y N
GRAND TOTAL
ACCESSORIAL SERVICES
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: $
Fee Terms: Collect: Prepaid:
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 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 freight and all other lawful charges.

X
(Shipper Signature if Section 7 applies)
SIGNATURES
SHIPPER SIGNATURE / PICKUP DATE
This is to certify that the above named materials are property classifled, described, packaged, marked, and labeled, and are in proper condition for transportation according to the applicable regulations of the U.S. DOT.

X
Trailer Loaded:
By Shipper
By Driver

Freight Counted:
By Shipper
By Driver/pallets said to contain
By Driver/Pieces 		CARRIER SIGNATURE / DELIVERY DATE
Carrier acknowledges receipt of packages and required placards. Carrier certifies emergency response information was made available and/or carrier has the U.S. DOT emergency response guidebook or equivalent documentation in the vehicle.
Property described above is received in good order, except as noted.

X