Date:

BILL OF LADING

SHIP FROM

Name:

Bill of Lading Number:

Address:

City/State/Zip:,

BAR CODE SPACE

SID#:

FOB: o

SHIP TO

CARRIER NAME: _________________________________

Name:

Location #: __________

Trailer number:

Address:

Seal number(s):

City/State/Zip:,

SCAC:

CID#:

FOB: o

Pro number:

THIRD PARTY FREIGHT CHARGES BILL TO:

Name:

BAR CODE SPACE

Address:

City/State/Zip:

Freight Charge Terms: (freight charges are prepaid unless marked otherwise)

SPECIAL INSTRUCTIONS:

Prepaid ________

Collect _______

3^rd Party ______

(check box)

Master Bill of Lading: with attached underlying Bills of Lading

CUSTOMER ORDER INFORMATION

CUSTOMER ORDER NUMBER

# PKGS

WEIGHT

PALLET/SLIP

(CIRCLE ONE)

ADDITIONAL SHIPPER INFO

GRAND TOTAL

CARRIER INFORMATION

HANDLING UNIT

PACKAGE

COMMODITY DESCRIPTION

LTL ONLY

QTY

TYPE

QTY

TYPE

WEIGHT

H.M.

(X)

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

NMFC #

CLASS

RECEIVING

STAMP SPACE

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

__________________ per ___________________.”

Fee Terms: Collect: ¨ Prepaid: o

Customer check acceptable: o

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 and 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 regulations.

The carrier shall not make delivery of this shipment without payment of freight and all other lawful charges.

_______________________________________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, packaged, marked and labeled, and are in proper condition for transportation according to the applicable regulations of the DOT.

p By Shipper

p By Driver

p By Shipper

p By Driver/pallets said to contain

Carrier acknowledges receipt of packages and required placards. Carrier certifies emergency response information was made available and/or carrier has the DOT emergency response guidebook or equivalent documentation in the vehicle.

Property described above is received in good order, except as noted.

p By Driver/Pieces

Signature Date