Your Company Name BILL OF LADING

Your Company Address

PICKUP FROM ADDITIONAL INFORMATION

PICKUP: DELIVERY:

INVOICE #: MODE:

CARRIER: PO#:

TRACKING #: PRO#:

DELIVER TO BILL TO

NOTES FREIGHT CHARGE TERMS

PREPAID COLLECT 3rd PARTY

PIECES PACKAGE DIMENSIONS WEIGHT VOLUME VOL WEIGHT H.M. (X) NM FC # CLASS

QTY PO ITEM / DESCRIPTION

PIECES WEIGHT VOLUME VOL. WEIGHT

PICKUP INSTRUCTIONS DELIVERY INSTRUCTIONS

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:
The agreed or declared value of the property is specifically stated by the shipper to be not exceeding
COD Amount: $
Fee Terms: Collect Prepaid
per
Customer Check Acceptance

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 The carrier shall not make delivery of this shipment
between the carrier and shipper, if applicable, otherwise to the rates, classifications and rules that have without payment of freight and all other lawful
been established by the carrier and are available to the shipper, on request, and to all applicable state charges.
and federal regulations.

SHIPPER SIGNATURE / DATE Trailer Loaded: Freight Counted: Shipper Signature:

This is to certify that the above named materials CARRIER SIGNATURE / PICKUP DATE
By Shipper By Shipper
are properly classified, described, packaged, Carrier acknowledges receipt of packages and
marked and labeled, and are in proper condition for By Driver/pallets required placards. Carrier certifies emergency
transportation according to the applicable By Driver said to contain response information was made available and/or
regulations of the U.S. DOT. carrier has the U.S. DOT emergency response
By Driver/Pieces guidebook or equivalent documentation in the
vehicle.
Property described above is received in good order,
except as noted.