Copyright Envision Corporation. 2002. All rights reserved.

Protected by the copyright laws of the United States & Canada and by international treaties. IT IS ILLEGAL AND STRICTLY
PROHIBITED TO DISTRIBUTE, PUBLISH, OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO ANY OTHER PARTY, THIS PRODUCT IN HARD COPY OR
DIGITAL FORM. ALL OFFENDERS WILL BE SUED IN A COURT OF LAW.

Bill of Lading Short Form Not Negotiable

Date

Ship From

Bill of Lading Number:

Name:
Address
City/State/Zip:
SID No.:

Bar Code Space

Ship To

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Carrier Name:
Trailer number:
Serial number(s):

Name:
Address:
City/State/Zip:
CID No.:

Third Party Freight Charges Bill to:

SPAC:

Name:
Address:

Pro Number:

Bar Code Space

City/State/Zip:
Special Instructions:

Freight Charge Terms:

Prepaid:

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Page 1 of

Collect:

3rd Party:

Master bill of lading with attached underlying bills of lading.

Customer Order Information

Customer Order No.

No. Pack-ages Weight

Pallet/Slip
(circle one)
Y

Additional Shipper Information

Grand Total

Carrier Information
Handling Unit
Qty

Type

Package
Qty

Typ
e

Weight

HM(X)

LTL Only
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.

Where the rate is dependent on value, shippers are required to state specifically in writing the agreed COD Amount: $______________________
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 ___________________. Free terms: Collect _, Prepaid _, Customer

NMFC No.

Class

check acceptable _

Note: Liability limitation for loss or damage in this shipment may be applicable.
Received, subject to individually determined rates or contracts that have been agreed
The
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.

carrier shall not make delivery of this shipment without full payment.

Shipper Signature____________________________________________

 Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States & Canada and by international treaties. IT IS ILLEGAL AND STRICTLY
PROHIBITED TO DISTRIBUTE, PUBLISH, OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO ANY OTHER PARTY, THIS PRODUCT IN HARD COPY OR
DIGITAL FORM. ALL OFFENDERS WILL BE SUED IN A COURT OF LAW.

Shipper Signature/Date

Trailer Loaded: Freight Counted:

Carrier Signature/Pickup Date

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.

_ By shipper

_ By shipper

_ By driver

_ By driver/pallets said to contain

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. Property
described above is received in good order, except as noted.

_ By driver/pieces

Signature
Signature

Date

Date