Standard Bill Of Lading Form
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4II. The Standard Bill of Lading Form
VICS Standard BOL: WWW. For Complete VICS BOL Guideline Information
Date:
BILL OF LADING
Page _______
SHIP FROM
Name:
Bill of Lading Number: ______________________
Address:
City/State/Zip:
B A R C O D E S P A C E
SID#:
FOB:
SHIP TO
CARRIER NAME: _______________________________
Name:
Location #: __________
Trailer number:
Address:
Seal number(s):
City/State/Zip:
SCAC:
CID#:
Pro number:
FOB:
THIRD PARTY FREIGHT CHARGES BILL TO:
Name:
B A R C O D E S P A C E
Address:
City/State/Zip:
Freight Charge Terms:
(freight charges are prepaid
unless marked otherwise)
rd
SPECIAL INSTRUCTIONS:
Prepaid ______
Collect _____
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Party _____
Master Bill of Lading: with attached
underlying Bills of Lading
(check box)
CUSTOMER ORDER INFORMATION
CUSTOMER ORDER NUMBER
# PKGS
WEIGHT
PALLET/SLIP
ADDITIONAL SHIPPER INFO
(CIRCLE ONE)
Y
N
Y
N
Y
N
Y
N
Y
N
GRAND TOTAL
CARRIER INFORMATION
HANDLING UNIT
PACKAGE
COMMODITY DESCRIPTION
LTL ONLY
Commodities requiring special or additional care or attention in handling or stowing
QTY
TYPE
QTY
TYPE
WEIGHT
H.M.
NMFC #
CLASS
must be so marked and packaged as to ensure safe transportation with ordinary care.
(X)
See Section 2(e) of NMFC Item 360
R E C E I V I N G
S T A M P S P A C E
GRAND TOTAL
Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or declared
COD Amount: $ ______________________
value of the property as follows:
“The agreed or declared value of the property is specifically stated by the shipper to be not exceeding
Fee Terms:
Collect:
Prepaid:
Customer check acceptable:
__________________ per ___________________.”
NOTE Liability Limitation for loss or damage in this shipment may be applicable. See 49 U.S.C. 14706(c)(1)(A) and (B).
RECEIVED, subject to individually determined rates or contracts that have been agreed upon in writing between
The carrier shall not make delivery of this shipment without payment of
the carrier and shipper, if applicable, otherwise to the rates, classifications and rules that have been established
freight and all other lawful charges.
by the carrier and are available to the shipper, on request, and to all applicable state and federal regulations.
_______________________________________Shipper
Signature
Trailer Loaded:
Freight Counted:
SHIPPER SIGNATURE / DATE
CARRIER SIGNATURE / PICKUP DATE
This is to certify that the above named materials are properly classified,
Carrier acknowledges receipt of packages and required placards. Carrier
By Shipper
By Shipper
packaged, marked and labeled, and are in proper condition for transportation
certifies emergency response information was made available and/or
according to the applicable regulations of the DOT.
carrier has the DOT emergency response guidebook or equivalent
By Driver
By Driver/pallets said to
documentation in the vehicle.
contain
Property described above is received in good order, except as noted.
By Driver/Pieces
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