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Bill of Lading
Ship From:




SID#: FOB 		Date:
Bill of Lading No:
BARCODE SPACE
Ship To:




CID#: FOB
Location No:
Carrier Name:
Trailer No:
Seal Number(s):

SCAC:
Pro No:
Third Party Freight Charges - Bill To:
BARCODE SPACE
Freight Charge Terms (prepaid unless marked otherwise)
Prepaid Collect 3rd Party
Master BOL: w/attached underlying BOLs
Special Instructions:
Customer Order Information
Customer Order No. # Pkgs. Weight Pallet/Slip
(Y/N)		 Additional Shipper Info
Y N
Y N
Y N
Y N
Totals
Carrier Information
Handling Unit Package Commodity Description LTL Only
QTY TYPE QTY TYPE NMFC No. Class
H.M.
H.M.
H.M.
Totals
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 Amt. $
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
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.

X
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.

X