©

Date
Bill of Lading – Short Form – Not Negotiable Page 1 of ________
C
Ship From Bill of Lading Number:______________________ o
Name: p
Address
City/State/Zip: y
SID No.: r
Ship To Carrier Name:_____________________________ i
Name: Trailer number: g
Address: Serial number(s):
h
City/State/Zip:
CID No.: t
Third Party Freight Charges Bill to: SPAC:
Name: Pro Number:
E
Address: n
City/State/Zip: v
i
Special Instructions: Freight Charge Terms: (Freight charges are prepaid unless s
marked otherwise) i
Prepaid: ____ Collect: _____ 3rd Party:____
o
 (check box): Master bill of lading with attached underlying bills n
of lading.
Customer Order Information
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Customer Order No. No. Pack- Weight Pallet/Slip Additional Shipper Information
ages (circle one) o
Y N r
Y N
p
o
Y N
r
Y N
a
Grand Total
t
Carrier Information i
Handling Package LTL Only
Unit
o
Qty Type Qty Type Weight HM Commodity Description NMFC Class
n
Commodities requiring special or additional care or attention in handling or stowing must be so
(X) marked and packaged as to ensure safe transportation with ordinary care. See Section 2(e) of No. .
NMFC item 360

2
0
0
2
.

A
Where the rate is dependent on value, shippers are required to state specifically in writing the COD Amount: $______________________
agreed or declared value of the property as follows: “The agreed or declared value of the property l
is specifically stated by the shipper to be not exceeding ______________ per Free terms: Collect _, Prepaid _, Customer check acceptable _
_________________________. l
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 that have been agreed
upon in writing between the carrier and shipper, if applicable, otherwise to the rates,
The carrier shall not make delivery of this shipment without payment of and r
all other lawful charges.
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. Shipper Signature_________________________________________
i
g
h
t
s

r
e
s
e
Shipper Signature/Date Trailer Loaded: Freight Counted: Carrier Signature/Pickup Date
This is to certify that the above named materials are _ By shipper _ By shipper Carrier acknowledges receipt of packages and required
properly classified, packaged, marked and labeled, and are placards. Carrier certifies emergency response information
in proper condition for transportation according to the _ By driver _ By driver/pallets said to contain was made available and/or carrier has the DOT emergency
applicable regulations of the DOT. response guidebook or equivalent documentation in the
_ By driver/pieces vehicle. Property described above is received in good
order, except as noted.