Bill of Lading Form

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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]
SID No.:
SHIP TO
Carrier Name:
[Name]
Trailer number:
[Street Address]
Serial number(s):
[City, ST ZIP Code]
CID No.:
THIRD PARTY FREIGHT CHARGES BILL TO
SCAC:
[Name]
Pro Number:
[Street Address]
[City, ST ZIP Code]
Special Instructions:
Freight Charge Terms
(Freight charges are prepaid unless marked otherwise):
Prepaid
Collect
3rd Party
Master bill of lading with attached underlying bills of lading.
CUSTOMER ORDER INFORMATION
Pallet/Slip
Customer Order No.
# of Packages
Weight
Additional Shipper Information
(circle one)
Y
N
Y
N
Y
N
Y
N
Grand Total
CARRIER INFORMATION
Handling Unit
Package
LTL Only
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
COD Amount: $
_____________________________________________
declared value of the property as follows: “The agreed or declared value of the property is specifically
Fee terms: Collect
Prepaid
Customer check acceptable
stated by the shipper to be not 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
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,
all other lawful fees.
classifications, and rules that have been established by the carrier and are available to
Shipper Signature
the shipper, on request, and to all applicable state and federal regulations.
________________________________________________________
Shipper Signature/Date
Trailer Loaded:
Freight Counted:
Carrier Signature/Pickup Date
By shipper
By shipper
_________________________________________
________________________________________
By driver
By driver/pallets said to contain
This is to certify that the above named materials are
Carrier acknowledges receipt of packages and required
By driver/pieces
properly classified, packaged, marked, and labeled, and are
placards. Carrier certifies emergency response information
in proper condition for transportation according to the
was made available and/or carrier has the DOT emergency
applicable regulations of the DOT.
response guidebook or equivalent documentation in the
vehicle. Property described above is received in good order,
except as noted.
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]
SID No.:
SHIP TO
Carrier Name:
[Name]
Trailer number:
[Street Address]
Serial number(s):
[City, ST ZIP Code]
CID No.:
THIRD PARTY FREIGHT CHARGES BILL TO
SCAC:
[Name]
Pro Number:
[Street Address]
[City, ST ZIP Code]
Special Instructions:
Freight Charge Terms
(Freight charges are prepaid unless marked otherwise):
Prepaid
Collect
3rd Party
Master bill of lading with attached underlying bills of lading.
CUSTOMER ORDER INFORMATION
Pallet/Slip
Customer Order No.
# of Packages
Weight
Additional Shipper Information
(circle one)
Y
N
Y
N
Y
N
Y
N
Grand Total
CARRIER INFORMATION
Handling Unit
Package
LTL Only
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
COD Amount: $
_____________________________________________
declared value of the property as follows: “The agreed or declared value of the property is specifically
Fee terms: Collect
Prepaid
Customer check acceptable
stated by the shipper to be not 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
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,
all other lawful fees.
classifications, and rules that have been established by the carrier and are available to
Shipper Signature
the shipper, on request, and to all applicable state and federal regulations.
________________________________________________________
Shipper Signature/Date
Trailer Loaded:
Freight Counted:
Carrier Signature/Pickup Date
By shipper
By shipper
_________________________________________
________________________________________
By driver
By driver/pallets said to contain
This is to certify that the above named materials are
Carrier acknowledges receipt of packages and required
By driver/pieces
properly classified, packaged, marked, and labeled, and are
placards. Carrier certifies emergency response information
in proper condition for transportation according to the
was made available and/or carrier has the DOT emergency
applicable regulations of the DOT.
response guidebook or equivalent documentation in the
vehicle. Property described above is received in good order,
except as noted.

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