Bill Of Lading Form
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1
2Date:
Page 1 of ______
BILL OF LADING
SHIP FROM
Name:
Bill of Lading Number:__________________
Address:
City/State/Zip:
B A R C O D E S P A C E
o
SID#:
FOB:
SHIP TO
CARRIER NAME: _________________________________
Name:
Location #:____ Trailer number:
Address:
Seal number(s):
City/State/Zip:
SCAC:
o
CID#:
Pro number:
FOB:
THIRD PARTY FREIGHT CHARGES BILL TO:
Name:
B A R C O D E S P A C E
Address:
City/State/Zip:
Freight Charge Terms:
(freight charges are prepaid
unless marked otherwise)
rd
Prepaid ________
Collect _______
3
Party ______
SPECIAL INSTRUCTIONS:
o
Master Bill of Lading: with attached
underlying Bills of Lading
(check box)
CUSTOMER ORDER INFORMATION
PALLET/SLIP
CUSTOMER ORDER NUMBER
# PKGS
WEIGHT
ADDITIONAL SHIPPER INFO
Y
or
N
GRAND TOTAL
CARRIER INFORMATION
HANDLING UNIT
PACKAGE
COMMODITY DESCRIPTION
LTL ONLY
Commodities requiring special or additional care or attention in handling or stowing must be
H.M.
QTY
TYPE
QTY
TYPE
NMFC #
CLASS
WEIGHT
so marked and packaged as to ensure safe transportation with ordinary care.
(X)
See Section 2(e) of NMFC Item 360
R E C E I V I N G
S T A M P S P A C E
GRAND TOTAL
Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or
COD Amount: $____________________
declared value of the property as follows:
Collect: ¨
Prepaid: o
“The agreed or declared value of the property is specifically stated by the shipper to be not exceeding
Fee Terms:
Customer check acceptable: o
__________________ per ___________________.”
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
The carrier shall not make delivery of this shipment without payment of freight
between the carrier and shipper, if applicable, otherwise to the rates, classifications and rules that have been
and all other lawful charges.
established by the carrier and are available to the shipper, on request, and to all applicable state and federal
_______________________________________Shipper Signature
regulations.
Trailer Loaded:
Freight Counted:
SHIPPER SIGNATURE / DATE
CARRIER SIGNATURE / PICKUP DATE
p
p
This is to certify that the above named materials are properly classified,
Carrier acknowledges receipt of packages and required placards. Carrier certifies
By Shipper
By Shipper
packaged, marked and labeled, and are in proper condition for
emergency response information was made available and/or carrier has the DOT
transportation according to the applicable regulations of the DOT.
emergency response guidebook or equivalent documentation in the vehicle.
p
p
Property described above is received in good order, except as noted.
By Driver
By Driver/pallets said to contain
p
By Driver/Pieces
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