Name Address City / State / Zip Sid No.: Freight Charges Prepaid Unless Marked Otherwise
Name Address City / State / Zip Sid No.: Freight Charges Prepaid Unless Marked Otherwise
Name Address City / State / Zip Sid No.: Freight Charges Prepaid Unless Marked Otherwise
SHIPPER B of L NO.
NAME
ADDRESS
SID NO.
CID NO.
ADDRESS
TELEPHONE
CUSTOMER ORDER NO. NO. OF PKGS WGT PALLET / SLIP ADDITIONAL SHIPPER INFO
Y N
Y N
Y N
Y N
TOTAL
HANDLING UNIT PACKAGE LTL, ONLY
QTY TYPE QTY TYPE WGT HM (X) DESCRIPTION OF ARTICLES, SPECIAL MARKS & EXCEPTIONS NMFC NO. CLASS
Where the rate is dependent on value, shippers are required to state specifically in writing COD AMOUNT $
the agreed or declared value of the property as follows: “The agreed or declared value
of the property is specifically stated by the shipper to be not exceeding _______________ FEE TERMS
per _______________.
COLLECT PREPAID CUSTOMER CHECK
NOTE: Liability limitation for loss or damage in this shipment may be applicable. See 49 USC § 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 shipment without payment of
agreed upon in writing between the carrier and shipper, if applicable, otherwise charges and all other lawful fees.
to the rates, classifications, and rules that have been established by the carrier
SHIPPER SIGNATURE
and are available to the shipper, on request, and to all applicable state and
federal regulations.
SHIPPER SIGNATURE & DATE CARRIER SIGNATURE & PICK-UP DATE TRAILER LOADED
BY SHIPPER
BY DRIVER
This is to certify that the above named materials are properly Carrier acknowledges receipt of packages and required FREIGHT COUNTED
classified, packaged, marked, and labeled, and are in placards. Carrier certifies emergency response information
BY SHIPPER
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 BY DRIVER/PALLETS
vehicle. Property described above is received in good order, SAID TO CONTAIN
except as noted.
BY DRIVER PIECES
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