BILL OF LADING – NON-NEGOTIABLE

SHIPPER	B of L NO.
NAME
ADDRESS
CITY / STATE / ZIP
SID NO.
Ship To	CARRIER NAME
NAME	TRAILER NO.
ADDRESS	SERIAL NOS.
CITY / STATE / ZIP
CID NO.
Third Party Freight Charges Bill to	SCAC
NAME	PRO NO.
ADDRESS
CITY / STATE / ZIP
TELEPHONE
SPECIAL INSTRUCTIONS	FREIGHT CHARGE TERMS Freight charges prepaid unless marked otherwise.
PREPAID	COLLECT	THIRD PARTY
Master bill of lading with attached underlying bills of lading.
CUSTOMER ORDER NO.	NO. OF PKGS	WGT	PALLET / SLIP	ADDITIONAL SHIPPER INFO
Y	N
Y	N
Y	N
Y	N
TOTAL
HANDLING UNIT	PACKAGE	LTL, ONLY
QTY	TYPE	QTY	TYPE	WGT	HM (X)	DESCRIPTION OF ARTICLES, SPECIAL MARKS & EXCEPTIONS	NMFC NO.	CLASS
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: “The agreed or declared value of the property is specifically stated by the shipper to be not exceeding _______________ per _______________.	COD AMOUNT $
FEE TERMS
COLLECT	PREPAID	CUSTOMER CHECK
NOTE: Liability limitation for loss or damage in this shipment may be applicable. See 49 USC § 14706(c)(1)(A) and (B).
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, and to all applicable state and federal regulations.	The carrier shall not make delivery of this shipment without payment of charges and all other lawful fees.
SHIPPER SIGNATURE
SHIPPER SIGNATURE & DATE	CARRIER SIGNATURE & PICK-UP DATE	TRAILER LOADED
BY SHIPPER
BY DRIVER
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.	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.	FREIGHT COUNTED
BY SHIPPER
BY DRIVER/PALLETS SAID TO CONTAIN
BY DRIVER PIECES

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