The Standard Bill Of Lading Form
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1
2II. The Standard Bill of Lading Form
VICS Standard BOL: For complete VICS BOL guideline information
BILL OF LADING
Date:
Page ________
SHIP FROM
Bill of Lading Number: ________________________________
Name:
Address:
BAR CODE SPACE
City/State/Zip:
SID#:
FOB:
SHIP TO
Carrier Name: ______________________________________
Name:
Location #: ___________
Trailer number:
Seal number(s):
Address:
City/State/Zip:
SCAC:
Pro number:
CID#:
FOB:
THIRD-PARTY FREIGHT CHARGES BILL TO:
BAR CODE SPACE
Name:
Address:
Freight Charge Terms:
(freight charges are prepaid unless
City/State/Zip:
marked otherwise)
Prepaid_______
Collect_______
3rd Party______
SPECIAL INSTRUCTIONS:
Master Bill of Lading: with attached underlying
Bills of Lading
(check box)
CUSTOMER ORDER INFORMATION
# PKGS
WEIGHT
PALLET/SLIP
ADDITIONAL SHIPPER INFO.
CUSTOMER ORDER NUMBER
(CIRCLE ONE)
Y
N
Y
N
Y
N
Y
N
GRAND TOTAL
CARRIER INFORMATION
HANDLING UNIT
PACKAGE
COMMODITY DESCRIPTION
LTL ONLY
WEIGHT
H.M.
Commodities requring special or additional care or attention in handling or stowing must
X
be so marked and packaged as to ensure safe transportation with ordinary care.
QTY
TYPE
QTY
TYPE
NMFC #
CLASS
See Section 2(e) of NMFC Item 360
RECEIVING
STAMP SPACE
GRAND TOTAL
COD Amount: $_______________________
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:
Fee Terms: Collect
Prepaid
“The agreed or declared value of the property is specifically stated by the shipper to be not exeeding
Customer check acceptable
__________________ per _______________________.
NOTE: Liability limitation for loss or damage in this shipment may be applicable. See 49 U.S.C. B 14706(c)(1)(A) and (B)
The carrier shall not make delivery of this shipment without payment of
RECEIVED, subject to individually determined rates or contracts that have been agreed upon in writing between the
freight and all other lawful charges.
carrier and shipper, if applicable, otherwise to the rates, classifications and rules that have been establed by the
carrier and are available to the shipper, on request, and to all applicable state and federal reguations.
Shipper Signature
_________________________________________
Trailer Loaded:
Freight Counted:
CARRIER SIGNATURE / PICKUP DATE
SHIPPER SIGNATURE / DATE
Carrier acknowledges receipt of packages and required placards.
This is to certify that the above-named materials are properly classified,
By Shipper
By Shipper
Carrier certifies emergency response information was made available
described, packaged, marked and labeled, and are in proper condition
By Driver / pallets said to
and/or carrier has the DOT emergency response guidebook or
for transportation according to the applicable regulations of the
By Driver
equivalent documentation in the vehicle.
Department of Transportation.
contain
Property described above is received in good order, except as noted.
By Driver/Pieces
________________________________________ __________________
_______________________________________ __________________
(Signature)
(Date)
(Signature)
(Date)
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