Bill Of Lading - Pahoa Express
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1[Date]
BILL OF LADING – SHORT FORM – NOT NEGOTIABLE
Page 1 of 1
SHIP FROM
Bill of Lading Number: _____________________________
[Name]
[Street Address]
[City, ST ZIP Code]
BAR CODE SPACE
SID No.: __________________
SHIP TO
Carrier Name: _____________________________
[Name]
Trailer number: __________________
[Street Address]
Serial number(s): __________________
[City, ST ZIP Code]
SID No.: __________________
THIRD PARTY FREIGHT CHARGES BILL TO
SCAC: _____________________________
[Name]
Pro Number: __________________
[Street Address]
[City, ST ZIP Code]
BAR CODE SPACE
Special Instructions: [Instructions]
Freight Charge Terms (Freight charges are prepaid unless marked otherwise):
Prepaid
Collect
3rd Party
CUSTOMER ORDER INFORMATION
Customer Order No.
# of Packages
Weight
Pallet/Slip
Additional Shipper Information
Yes
No
Yes
No
Yes
No
Yes
No
Grand Total
CARRIER INFORMATION
LTL Only
Package
Handling Unit
Qty
Type
Qty
Type
Weight
HM (X)
Commodity Description
NMFC No.
Class
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
Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or declared value of
COD Amount:
Fee terms:
the property as follows: “The agreed or declared value of the property is specifically stated by the shipper to be not
$ ____________
Collect
Prepaid
Customer check acceptable
exceeding ______________ per ______________.
Note: Liability limitation for loss or damage in this shipment may be applicable. See 49 USC § 14706(c)(1)(A) and (B).
The carrier shall not make delivery of this shipment without payment of charges and all other
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
lawful fees.
rules that have been established by the carrier and are available to the shipper, on request, and
Shipper Signature ________________________________________________________
to all applicable state and federal regulations.
Shipper Signature/Date
Trailer Loaded:
Freight Counted:
Carrier Signature/Date
_____________________________________
_____________________________________
By shipper
By shipper
This is to certify that the above named materials are properly
Carrier acknowledges receipt of packages and required placards. Carrier
classified, packaged, marked, and labeled, and are in proper
certifies emergency response information was made available and/or
By driver
By driver/pallets said to contain
condition for transportation according to the applicable
carrier has the DOT emergency response guidebook or equivalent
regulations of the DOT.
documentation in the vehicle. Property described above is received in
By driver/pieces
good order, except as noted.
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