BILL OF LADING - SHORT FORM

1

SID No.

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Bill of Lading Number

3

Carrier Name

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SHIP TO

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Trailer number

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Serial number(s)

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SCAC

8

THIRD PARTY FREIGHT CHARGES BILL TO

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Pro Number

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Freight Charge Terms (Freight charges are prepaid unless marked otherwise):

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Special Instructions

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Prepaid

Collect

3rd Party

Freight Charge Terms (Freight charges are prepaid unless marked otherwise):

Master bill of lading with attached underlying bills of lading.

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Additional Shipper Information

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Grand Total

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Commodity Description Commodities requiring special or additional care or attention in handling or stowing must be so marked and packaged as to ensure safe transportation with ordinary care. See Section 2(e) of NMFC item 360

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

16

COD Amount

Fee terms: Collect

Prepaid

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COD Amount

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Customer check acceptable

19

Note: Liability limitation for loss or damage in this shipment may be applicable. See 49 USC § 14706(c1A 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.

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Shipper Signature

Clear

21

Signature

Clear

22

Signature

Clear

23

Shipper Signature/Date

Clear

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Carrier Signature/Pickup Date

Clear

25

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.

By shipper By driver

Freight Counted: By shipper By driver/pallets said to contain By driver/pieces

Trailer Loaded:

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.

26

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 Signature/Pickup Date