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COMPANY LOGO (if desired)

Date: Bill of Lading – Short Form – Not Negotiable Page 1 of

Ship From SHIPPER’S #:
City/State/Zip Bar Code Space
Ship To Carrier Name:
Trailer number:
Address Serial number(s):
Phone SPAC:
Third Party Freight Charges Bill to: Pro Number:
Address: Bar Code Space
Freight Charge Terms: Freight charges
Special Instructions: are prepaid unless marked otherwise
Prepaid: Collect: 3rd Party:
(check box): Master bill of lading with attached underlying bills of

Package Carrier Information LTL Only

Qty Type Weight HM Commodity Description NMFC Class
(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

Where the rate is dependant on value, shippers are required to state COD Amount: $_______________
specifically in writing the agreed or declared value of the property as Free Terms: Collect ___, Prepaid ___,
follows: “The agreed or declared value of the property is specifically 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 ss 14706(c)
(1)(A) and (b)
Received, subject to individually determined rates or contracts that have been The carrier shall not make delivery of this
agreed upon in writing between the carrier and shipper, if applicable, otherwise shipment without payment of and all other
to the rates, classification and rules that have been established by the carrier lawful charges.
and are available to the shipper, on request, and to all applicable state and
federal regulations
Shipper Signature______________________
This is to certify that the above named Trailer loaded: Carrier acknowledges receipt of packages and
materials are properly classified, packaged, __By shipper required placards. Carrier certifies emergency
marked and labeled, and are in proper __By driver response information was made available
condition for transportation according to the Freight counted: and/or carrier has the DOT required
applicable regulations of the DOT. __By shipper emergency response guidebook or equivalent
Shipper Signature/Date __By driver/pallets documentation. Property described above is
said to contain received in good order, except as noted.
__By driver/pieces Carrier Signature/Pickup Date