Date: Page

BILL OF LADING
SHIP
Name: FROM Bill of Lading Number:
Address:
City/State/Zip: B AR C O D E S PAC E
SID#: FOB: 
SHIP TO CARRIER NAME:
Name: Location #: Trailer number:
Address: Seal number(s):
City/State/Zip: SCAC:
CID#: FOB:  Pro number:
THIRD PARTY FREIGHT CHARGES BILL TO:
Name: B AR C O D E S PAC E
Address:

City/State/Zip: Freight Charge Terms: (freight charges are prepaid unless

marked otherwise)
SPECIAL INSTRUCTIONS: Prepaid Collect 3rd Party

 Master Bill of Lading: with attached

(check box) underlying Bills of Lading
CUSTOMER ORDER INFORMATION
CUSTOMER ORDER NUMBER # PKGS WEIGHT PALLET/SLIP ADDITIONAL SHIPPER INFO
(CIRCLE ONE)
Y N
Y N
Y N
Y N
Y N

GRAND TOTAL
CARRIER INFORMATION
HANDLING UNIT PACKAGE COMMODITY DESCRIPTION LTL ONLY
H.M. Commodities requiring special or additional care or attention in handling or stowing must be
QTY TYPE QTY TYPE WEIGHT so marked and packaged as to ensure safe transportation with ordinary care.
NMFC # CLA
(X) See Section 2(e) of NMFC Item 360 SS

RECEIVING
S T A M P S PAC E

GRAND TOTAL
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:
COD Amount: $
“The agreed or declared value of the property is specifically stated by the shipper to be not exceeding
Fee Terms: Collect:  Prepaid: 
per .” 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 The carrier shall not make delivery of this shipment without payment of
and shipper, if applicable, otherwise to the rates, classifications and rules that have been established by the carrier and are freight and all other lawful charges.
available to the shipper, on request, and to all applicable state and federal regulations.
Shipper
Signature
SHIPPER SIGNATURE / DATE Trailer Loaded: Freight Counted: CARRIER SIGNATURE / PICKUP DATE
This is to certify that the above named materials are properly classified, described,
packaged, marked and labeled, and are in proper condition for transportation  By Shipper  By Shipper Carrier acknowledges receipt of packages and required placards. Carrier
certifies emergency response information was made available and/or

 By Driver  By Driver/pallets said to contain

according to the applicable regulations of the U.S. DOT. carrier has the U.S. DOT emergency response guidebook or equivalent
documentation in the vehicle.

 By Driver/Pieces Property described above is received in good order, except as noted.

Date: Page
SUPPLEMENT TO THE BILL OF LADING
Bill of Lading Number:

CUSTOMER ORDER INFORMATION

CUSTOMER ORDER NUMBER # PKGS WEIGHT PALLET/SLIP ADDITIONAL SHIPPER INFO
(CIRCLE ONE)
Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

PAGE SUBTOTAL
CARRIER INFORMATION
HANDLING UNIT PACKAGE COMMODITY DESCRIPTION LTL ONLY
Commodities requiring special or additional care or attention in handling or stowing must be
QTY TYPE QTY TYPE WEIGHT H.M. so marked and packaged as to ensure safe transportation with ordinary care. NMFC # CLASS
(X) See Section 2(e) of NMFC Item 360

PAGE SUBTOTAL