BILL OF LADING – NON-NEGOTIABLE

SHIPPER B of L NO.
NAME

ADDRESS
CITY / STATE /
ZIP

SID NO.
CARRIER
SHIP TO
NAME
NAME TRAILER NO.
ADDRESS SERIAL NOS.
CITY / STATE /
ZIP

CID NO.
THIRD PARTY FREIGHT CHARGES BILL TO SCAC
NAME PRO NO.
ADDRESS
CITY / STATE /
ZIP

TELEPHONE

SPECIAL INSTRUCTIONS FREIGHT CHARGE TERMS

Freight charges prepaid unless marked otherwise.

PREPAID COLLECT THIRD PARTY

Master bill of lading with attached underlying bills of lading.
PALLET /
CUSTOMER ORDER NO. NO. OF PKGS WGT ADDITIONAL SHIPPER INFO
SLIP
Y N
Y N
Y N
Y N
TOTAL
HANDLING
PACKAGE LTL, ONLY
UNIT
QTY TYPE QTY TYPE WGT HM (X) DESCRIPTION OF ARTICLES, SPECIAL MARKS & NMFC NO. CLASS
EXCEPTIONS

Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or COD AMOUNT $
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 _______________ per _______________. FEE TERMS

PREPAI CUSTOMER
COLLECT
D CHECK
NOTE: Liability limitation for loss or damage in this shipment may be applicable. See 49 USC § 14706(c)(1)(A) and (B).
The carrier shall not make delivery of this shipment without payment of charges and
Received, subject to individually determined rates or contracts that have been agreed upon in all other lawful fees.
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 SHIPPER SIGNATURE
all applicable state 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 classified, Carrier acknowledges receipt of packages and required placards. Carrier FREIGHT COUNTED
packaged, marked, and labeled, and are in proper condition for certifies emergency response information was made available and/or
BY SHIPPER
transportation according to the applicable regulations of the DOT. carrier has the DOT emergency response guidebook or equivalent
documentation in the vehicle. Property described above is received in BY DRIVER/PALLETS
good order, except as noted. SAID TO CONTAIN
BY DRIVER PIECES