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Get Bill of Lading Short Form

Date BILL OF LADING SHORT FORM NOT NEGOTIABLE SHIP FROM Page 1 of 1 Bill of Lading Number Name Street Address City ST ZIP Code SID No. SHIP TO Carrier Name Trailer number Serial number s THIRD PARTY FREIGHT CHARGES BILL TO SCAC Pro Number Special Instructions Freight Charge Terms Freight charges are prepaid unless marked otherwise Prepaid Collect 3rd Party Master bill of lading with attached underlying bills of lading. CUSTOMER ORDER INFORMATION Customer Order No* of Packages Weight Pallet/Slip circle one Y N Additional Shipper Information Grand Total CARRIER INFORMATION Handling Unit Qty Type LTL Only HM X Commodity Description Commodities requiring special or additional care or attention in handling or stowing must be so marked and packaged as to ensure safe transportation with ordinary care. See Section 2 e of NMFC item 360 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 per. COD Amount Fee terms Collect NMFC No* Class Customer check acceptable 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 agreed upon in 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 all applicable state and federal regulations. The carrier shall not make delivery of this shipment without payment of charges and all other lawful fees. Shipper Signature Freight Counted By shipper By driver/pallets said to contain By driver/pieces This is to certify that the above named materials are properly classified packaged marked and labeled and are in proper condition for transportation according to the applicable regulations of the DOT. Trailer Loaded By driver Carrier Signature/Pickup Date Carrier acknowledges receipt of packages and required placards. Carrier certifies emergency response information was made available and/or carrier has the DOT emergency response guidebook or equivalent documentation in the vehicle. CUSTOMER ORDER INFORMATION Customer Order No* of Packages Weight Pallet/Slip circle one Y N Additional Shipper Information Grand Total CARRIER INFORMATION Handling Unit Qty Type LTL Only HM X Commodity Description Commodities requiring special or additional care or attention in handling or stowing must be so marked and packaged as to ensure safe transportation with ordinary care. See Section 2 e of NMFC item 360 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 per. See Section 2 e of NMFC item 360 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 per. COD Amount Fee terms Collect NMFC No* Class Customer check acceptable Note Liability limitation for loss or damage in this shipment may be applicable. .

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