
Carrrier Address
*HQ
Number Shipping
Units
Kinds of Packaging, Description of Articles, Special Marks and Exceptions Code
Weight Subject to
Correction
Rate Charges
City
State & Zip SID NO.
FOR PAYMENT: SEND BILL TO
Shipper's Internal Data
Name
Address
City
State and Zip
FROM: Shipper
Special Instructions
Address
City
State and Zip
TO: Consignee
Trailer/Car Number
Address
Route
State and Zip SAC DUNS
Date
City
FREIGHT BILL PRO NO.
Carrier Name
Phone SHIPMENT IDENTIFICATION NO.
MT: $ $
$
State & Zip
$ per
Signature of Consignor CHECK BOX IF COLLECT
CHARGES
The carrier shall not make delivery of this
shipment without payment of freight and all other
lawful charges.
Freight charges are
prepaid unless
marked collect
The agreed or declared vlaue of the property is hereby specifically stated by the shipper t
be not exceeding
City
Subject to Section 7 of conditions, if this shipment
is to be delivered to the consignee without
recourse on the consignor, the consignor shall
sign the following statement.
COLLECT
TOTAL
$
in writing the agreed or declared value of the property.
COD
Address
PREPAID
REMIT C.O.D. TO:
RECEIVED, subject to the classifications and lawfully filed tariffs in effect on the date of the issue of this Bill of Lading, the property described above in apparent good order, except as noted (contents and
conditions of contents of packages unknown), marked consigned and destined as indicated above which said carrier (the word carrier being understood throughout this contract as meaning any person or
corporation in possession of the property under the contract) agrees to carry to its usual place of delivery at said destination, if on its route, otherwise to deliver to another carrier on the route to its destination. It is
mutually agreed as to each carrier of all or any of the said property, over all or any portion of said route to destination and as to each party at any time interested in all or any of said property, that every service to
be performed hereunder shall be subject to the bill of lading terms and conditions in the governing classification on the date of shipment. Shipper hereby certifies that he is familiar with all the bill of lading terms
and conditions in the governing classification and the said terms and conditions are hereby agreed to by the shipper and accepted for himself and his assigns.
NOTE - Where the rate is dependant on value, shippers are required to state specifically
C.O.D. FEE
STRAIGHT BILL OF LADING - SHORT FORM
SHIPPER CARRIER
PER PER
* Mark "X" or "RQ" if appropriate to designate Hazardous Materials as defined in the Department of Transport Regulations governing the transportation of hazardous materials. The use of this column is an
optional method for identifying hazardous materials on bills of lading per Section172.201(a)(1)(iii) of Title 49, Code of Federal Regulations. Also, when shipping hazardous materials the shipper's certification
statement prescribed in Section 172.204(a) of the Federal Regulations must be indicated on the bill of lading, unless a specific exemption fom this requirement is provided in the Regulations for a particular
material.