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© Copyright Envision Corporation. 2002. All rights reserved.

Protected by the copyright laws of the United States & Canada and by international treaties. IT IS ILLEGAL AND STRICTLY
PROHIBITED TO DISTRIBUTE, PUBLISH, OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO ANY OTHER PARTY, THIS PRODUCT IN HARD COPY OR
DIGITAL FORM. ALL OFFENDERS WILL BE SUED IN A COURT OF LAW.

Date Page 1 of
Bill of Lading – Short Form – Not Negotiable
Ship From Bill of Lading Number:
Name:
Address
City/State/Zip: Bar Code Space
SID No.:
Ship To Carrier Name:
©
Name: Trailer number:
Address: Serial number(s):
C City/State/Zip:
o CID No.:
p Third Party Freight Charges Bill to: SPAC:
y Name: Pro Number:
r Address:
Bar Code Space
i City/State/Zip:
g Special Instructions: Freight Charge Terms:
h Prepaid: Collect: 3rd Party:
t Master bill of lading with attached underlying bills of lading.
Customer Order Information
E Customer Order No. No. Pack-ages Weight Pallet/Slip Additional Shipper Information
n (circle one)
v Y N
i Y N
s Y N
i Grand Total
o
Carrier Information
n Handling Unit Package LTL Only
Qty Type Qty Ty Weight HM(X) Commodity Description NMFC Class
C p Commodities requiring special or additional care or attention in handling or
No.
stowing must be so marked and packaged as to ensure safe transportation
o e with ordinary care.

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i 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
COD Amount: $______________________
o specifically stated by the shipper to be not exceeding ______________ per ___________________. Free terms: Collect _, Prepaid _, Customer check acceptable _
n Note: Liability limitation for loss or damage in this shipment may be applicable.
. 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,
The carrier shall not make delivery of this shipment without full payment.
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.
2 Shipper Signature____________________________________________
0 Shipper Signature/Date Trailer Freight Counted: Carrier Signature/Pickup Date
0 This is to certify that the above named materials are properly Loaded:
_ By shipper Carrier acknowledges receipt of packages and required
classified, packaged, marked and labeled, and are in proper placards. Carrier certifies emergency response information
_ By shipper
2 condition for transportation according to the applicable _ By driver/pallets said to contain was made available and/or carrier has the DOT emergency
regulations of the DOT. _ By driver response guidebook or equivalent documentation in the
. _ By driver/pieces vehicle. Property described above is received in good
order, except as noted.

A Signature Date Signature Date


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