Straight Bill Of Lading - Short Form - Not Negotiable printable pdf download

STRAIGHT BILL OF LADING – SHORT FORM –

Date:

NOT NEGOTIABLE

Dalrymple Job Number:

SHIP FROM

Purchase Order Number:

SHIP TO

Carrier Name:

THIRD PARTY FREIGHT CHARGES BILL TO

NOTES

Special Instructions:

Freight Charge Terms

(Freight charges are prepaid unless marked otherwise):

Prepaid



Collect



3rd Party



CUSTOMER ORDER INFORMATION

Equipment Information & Serial Number(s):

# of Packages

Weight

Additional Shipper Information

Where the rate is dependent on value, shippers are required to state specifically

COD Amount: $

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

Fee terms: 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).

Received, subject to individually determined rates or contracts

The carrier shall not make delivery of this shipment without payment of charges and

that have been agreed upon in writing between the carrier and

all other lawful fees.

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

Shipper Signature

________________________________________________________

regulations.

Shipper Signature/Date:

Trailer Loaded:

Load Inspected By:

Carrier Signature/Pickup Date:

________________________________________

By shipper



Carrier acknowledges receipt of packages

By driver



_________________________________________

and required placards. Carrier certifies

_________________________________

This is to certify that the above named

Signature

emergency response information was made

materials are properly classified, packaged,

available and/or carrier has the DOT

marked, and labeled, and are in proper

emergency response guidebook or equivalent

condition for transportation according to the

documentation in the vehicle. Property

applicable regulations of the DOT.

described above is received in good order,

except as noted.

Straight Bill Of Lading - Short Form - Not Negotiable

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