Bill of Lading Number

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DOCUMENTOS DE TRANSPORTE:

BILL OF LADING

Date: BILL OF LADING Page


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:


(freight charges are prepaid unless marked collect)
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/S ADDITIONAL SHIPPER INFO
LIP
(CIRCLE ONE)
Y N
Y N
Y N
Y N
Y N
GRAND TOTAL
CARRIER
INFORMATION
HANDLING PACKAGE COMMODITY DESCRIPTION LTL ONLY
UNIT
Commodities requiring special or additional care or attention in handling or
QT TYP QTY TYP WEIGHT H. stowing must be so marked and packaged as to ensure safe transportation with NMFC # CLAS
Y E E M. ordinary care. S
See Section 2(e) of NMFC Item
(X 360
)

RECEIVING
STAMP SPACE

GRAND TOTAL
Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or declared COD Amount: $
value of the property as follows: Noting a value is not a request for Additional Cargo Liability under OD Rules 100, Item
574. Fee Terms: Collect: Prepaid:
“The agreed or declared value of the property is specifically stated by the shipper to be not exceeding
Personal/company check NOT
per .”
acceptable:
NOTE - Liability Limitation applies. See OD Rules 100, Items 574 and 594.
RECEIVED, subject to the rates, classifications and rules that have been established by the Carrier and are available on The carrier shall not make delivery of this shipment without
request to the Shipper (Shipper defined in 49 U.S.C.A. § 13102(13)(c)), and to all applicable state and federal regulations. payment of freight and all other lawful charges.
Shipper 1) warrants it has read all applicable contract(s) or Carrier’s applicable tariff(s) and the limitation of liability
provisions set forth therein; and 2) has actual knowledge of and accepts the applicable contract or tariff terms, including the
limits on carrier liability. Carriers’ tariff(s), including OD Rules 100, take precedence in the event of any terms or conditions Shipper Signature
conflicts.
SHIPPER SIGNATURE / DATE Trailer Loaded: Freight Counted: CARRIER SIGNATURE / PICKUP DATE
This is to certify that the above named materials are properly Carrier acknowledges receipt of packages and required placards.
classified, described, packaged, marked and labeled, and are in By Shipper By Shipper Carrier certifies emergency response information was made available
proper condition for transportation according to the applicable and/or carrier has the U.S. DOT emergency response guidebook or
regulations of the U.S. DOT. By Driver By Driver/pallets said to equivalent documentation in the vehicle.
contain
Property described above is received in good order, except as
noted.
By Driver/Pieces
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