BILL OF LADING	Page 1 of ______	
SHIP FROM		
Name:	Bill of Lading Number: ________________________ 	
Address:		
City/State/Zip:	BAR CODE SPACE	
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:	BAR CODE SPACE	
Address:		
City/State/Zip:	Freight Charge Terms:	
SPECIAL INSTRUCTIONS:	Prepaid ________	Collect _______	3rd 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	
			Y	N		
			Y	N		
			Y	N		
			Y	N		
			Y	N		
			Y	N		
			Y	N		
			Y	N		
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. 	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: 
                      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 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.	  By Shipper
  By Driver	  By Shipper
  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.	
		  By Driver/Pieces