SHIPPER (FROM):
Name:  
Street:
City:      State: ZIP:
Phone: Fax: 		CONSIGNEE (TO):
Name:  
Street:
City:      State: ZIP:
Phone: Fax:
Bill of Lading#
Shipper's Ref#
Customer's PO#
 Freight Charges*

Prepaid: Shipper responsible for payment
Collect: Consignee responsible for payment
3rd Party: Payment by party other than above

*Payment of all charges due prior to delivery of freight

 THIRD PARTY BILL TO:
Name:  
Street:
City:      State: ZIP:
Phone: Fax:
C.O.D. Amount
$ 		C.O.D. Fee - Prepaid or Collect?
 Customer check acceptable?
 Acceptable remittance?
Number
of Pieces		 Kind of pieces Hazardous DESCRIPTION of articles,
SPECIAL MARKS and EXCEPTIONS		 Weight (lbs) Class
or Rate
Note: Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or declared value of the property.

Household goods are expressly released to a value of $0.10 per pound.

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

$ per

Acceptance of Page 2, "Contract Terms and Conditions," are required to complete this Bill of Lading.

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