Straight Bill Of Lading Short Form

B

STRAIGHT BILL OF LADING—SHORT FORM

ORIGINAL—NOT NEGOTIABLE

Carrier’s Pro No. _______________________

Shipper’s Bill of Lading No. _______________

Consignee’s Reference/PO No.____________

Name of Carrier ______________________________________________________________________________ Carrier’s Code (SCAC) __________________

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;

From _________________________________________________________________________________________________ Date _______________________

Street __________________________ City ________________________ County _____________________________ State __________ Zip _____________

the property described below, in apparent good order, except as noted (contents and condition of contents of packages unknown) marked, consigned, and destined as shown below, which said

carrier agrees to carry to destination. It is mutually agreed, that every service to be performed hereunder shall be subject to all the terms and conditions of the Uniform Bill of Lading set forth in

the National Motor Freight Classification 100-X and successive issues, except where in conflict, provisions herein will take precedence. The shipper hereby certifies that he is familiar with all the

terms and conditions of the said bill of lading, including those on the back thereof, and the said terms and conditions are hereby agreed to by the shipper and accepted for himself and his assigns.

Consigned to ______________________________________________________________________________________________________________________

On Collect on Delivery Shipments, the letters “COD” must appear before consignee’s name.

Destination Street___________________________________________________________________________________________________________________

City ____________________________________________ County _________________________________________ State ___________ Zip ____________

Delivering Carrier _________________________________________________________________ Trailer No. ________________________________________

Additional Shipment Information _______________________________________________________________________________________________________

▫

Collect on Delivery $ ____________________________________ and remit to: _____________________________

C.O.D. charge

Shipper

▫

Street ________________________________________________ City_____________________ State _________

to be paid by

Consignee

✪

Handling

Packages

Kind of Package, Description of Articles, Special Marks and Exceptions

Weight

Class or

Cube

Units

(Subject to correction)

No.

(Subject to

Rate Ref.

(Optional)

HM

No.

Type

Correction)

(For Info.

Type

Only)

✪

Mark “X” to designate Hazardous Materials as defined in DOT Regulations.

Freight charges are PREPAID

NOTE (1) Where the rate is dependent on value, shippers are required to state specifically in writing the agreed

▫

unless marked collect.

or declared value of the property as follows:

CHECK BOX IF COLLECT

“The agreed or declared value of the property is specifically stated by the shipper to be not exceeding

_________per _________.”

FOR FREIGHT COLLECT SHIPMENTS:

NOTE (2) Liability Limitation for loss or damage on this shipment

If this shipment is to be delivered to the consignee, without recourse

on the consignor, the consignor shall sign the following statement:

shall not exceed $200,000, unless additional insurance is obtained

The carrier may decline to make delivery of this shipment without

through the carrier.

payment of freight and all other lawful charges.

(a) As a condition precedent to recovery, claims must be filed in writing with: any participating carrier

having sufficient information to identify the shipment.

(Signature of Consignor)

(b) Claims for loss or damage must be filed within nine months after the delivery of the property (or, in the

case of export traffic, within nine months after delivery at the port of export), except that claims for failure to

make delivery must be filed within nine months after a reasonable time for delivery has elapsed.Where claims

NOTE (3) Commodities requiring special or additional care or attention in

for loss or damage are not filed within the applicable nine month period no carrier shall be liable and such

handling or stowing must be so marked and packaged as to ensure safe

claims shall not be paid.

transportation with ordinary care. See Sec. 2(e) of NMFC Item 360.

(c) Suits for loss, damage, injury or delay shall be instituted against any carrier no later than two years and

one day from the day when written notice is given by the carrier to the claimant that the carrier has disallowed

the claim or any part or parts of the claim specified in the notice. Where claims are not filed or suits are not insti-

tuted thereon in accordance with the foregoing provisions, no carrier shall be liable, and such claims will not be paid.

Notify if problem enroute or at delivery ________________________________________________________________________(for informational purposes only)

Name

Fax No.

Tel. No.

Send freight bill to:__________________________________________________________________________________________________________________

Company Name

City

Street

State

Zip

Shipper______________________________________________Carrier _______________________________________________________________________

Per __________________________________________

Per __________________________________________

Date _________________

Shipper Certification

Carrier Certification

Carrier acknowledges receipt of packages and required placards. Carrier certifies emergency response information was made

This is to certify that the above named materials are properly classified,

available and/or carrier has the DOT emergency response guidebook or equivalent document in the vehicle.

packaged, marked and labeled, and are in proper condition for

transportation according to the applicable regulations of the DOT.

Per ___________________________________________________________________ Package Nos. __________________

Per__________________________________Date ________________

Date_________________________________________________________________________________________________

FM SA 23(02)