Fill and Sign the Bill of Lading Form

Bill of LadingTRAILER/CAR NUMBER: __________________ BILL DATE: __________________ TO FROM Consignee Shipper Street Street Destination Origin City/State/Zip City/State/Zip Route: Special Instructions: FOR PAYMENT, SEND BILL TO SHIPPER'S INSTRUCTIONS Name Company Street City/State/Zip NO. SHIPPING UNITS TIME DESCRIPTION OF ARTICLES SPECIAL MARKS & EXCEPTIONS WT. RATE CHARGES REMIT C.O.D. C.O.D. AMOUNT: $ C.O.D. FEE PREPAID ฀ COLLECT ฀ TO: ADDRESS: If this shipment is to be delivered to the consignee without recourse on the consignor, the consignor shall sign the following statement: The carrier shall not make delivery of this shipment without payment of freight and all other lawful charges. ____________________ (Signature of Consignor) TOTAL CHARGES $ NOTE: Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or declared value of the property. The agreed or declared value of the property is hereby specifically stated by the shipper to be not exceed $_____________ per Freight Charges are collect unless market prepaid CHECK BOX IF PREPAID ฀ RECEIVED subject to the classifications and 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 condition of packages unknown), marked consigned and destined as indicated above which said carrier (the word carrier being understood through 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 as said destination. If on its route, otherwise to deliver to another carrier on the route to said destination. It is mutually agreed as to each carrier of all or any of 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 said property, that every service to be performed hereunder shall be subject to all 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. Shipper Carrier Per Per Date: Mark with “X” or “RQ” if appropriate to designate Hazardous Materials Substances as defined in the Department of Transportation Regulations governing the transportation of hazardous materials. The use of this column is an optional method for identifying hazardous materials on Bills of Lading 172.201(a)(1) (iii) of Title 4 9. Code of Federal Regulations. Also when shipping hazardous materials, the shipper' s certification statement prescribed in section 172.204(a) of the Federal Regulations, as indicated on the Bill of Lading does apply, unless a specific exception from the requirement is pro vided in t he Regulation for a particular material.