Fillable Printable Sample Form for Bill of Lading
Fillable Printable Sample Form for Bill of Lading
Sample Form for Bill of Lading
6
Date:
BILL OF LADING
Page 1 of ______
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 otherwise)
SPECIAL INSTRUCTIONS:
Prepai d ________ Coll ect _______ 3
rd
Party ______
(check box)
Master Bill of Lading: with at tached underlyi ng
Bills of Lading
CUSTOM E R ORDER INFORMATIO N
CUSTOMER ORDER NUMBER # PKGS WEIGHT
PALLET/SLIP
(CIRCLE ONE)
ADDITI ONAL SHIPPER INFO
YN
YN
YN
YN
YN
YN
YN
YN
GRAND TOTAL
CARRIE R INFORMATIO N
HANDLING UNIT
PACKAGE
COMMODITY DESCRIPTION LTL ONLY
QTY TYPE QTY TYPE
WEIGHT
H.M.
(X)
Commodities requiring special or additional c ar e or attent ion i n handli ng or stowing must be so
marked and packaged as to ensure safe transport ation with ordi nar y c ar e.
See Secti on 2(e) o f NMF C It em 360
NMFC # CLASS
RECEIVING
STAMP SPACE
GRAND TOTAL
Where the rate is dependent on value, shippers are required to state specifi cally in writing the agreed or
declared val ue of the property as follows:
COD Amount: $ ______________________
“The agreed or declared value of the property is specificall y stated by the shipper to be not exceeding
__________________ per ___________________.”
Fee Terms: Collect:
Prepaid:
Customer check acceptabl e:
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
between the carrier and shipper, if applicable, otherwise to the rates, classifications and rules that have been
establi shed by the carrier and are available to the shipper, on request, and to all applicable state and federal
regulati ons.
The carrier shall not make delivery of this shipment without payment of freight
and all other lawful charges.
_______________________________________Shipper Signature
SHIPPER SIGNATURE / DATE
Trailer Loaded: Freight Count ed:
CARRIER SIGNATURE / PICKUP DATE
Thi s is to cert ify that the above named mat er ial s are pr oper ly classified,
packaged, mark ed and labeled, and are i n pr oper condition for
transport ation ac c or ding to the applicabl e regulat ions of the DOT .
By Shipper
By Driver
By Shipper
By Driver/pallets said to contain
Carrier acknowledges receipt of pac k ages and required pl ac ar ds. Car r ier cer tifies
emergency response information was made available and/or c ar r ier has the DO T
emergency response guidebook or equivalent document ation in the vehic le.
Property describ ed above is received in good order, except as noted.
By Driver/Pieces
