BILL OF LADING

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  • Fields marked with * are required.
 
General Information
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* Are you the:
Shipper Consignee Bill To
* Payment Terms:
Prepaid Collect
* Shipment Date:
Rate Quote #:
 
Requestor Contact Information
* Contact Name:
* Email:
* Phone Number
Ext. (Please type numbers only)
 
Consignee Information
Contact Name:
Email:
(Consignee notifications will be emailed to this address)
Customer Number:
* Company:
* Street Address:

* City:
* State: * Zip:
* Phone Number:
Ext. (Please type numbers only)
 
Shipper Information
* Contact Name:
E-mail:
Customer Number:
* Company:
* Street Address

* City:
* State: * Zip:
* Phone Number:
Ext. (Please type numbers only)
 
Billing Information
Contact Name:
E-mail:
Customer Number:
* Bill To Company:
* Mailing Address:

* City:
* State: * Zip: Zip+4 Ext:
* Phone Number:
Ext. (Please type numbers only)
 
Reference Numbers
Bill of Lading #
Shipper's #
PO #
 
Shipment Information
Number of Lines:
 

Line 1:
# of Pieces *
# of
Handling Units
Type of
Handling Units *
Haz Mat
Yes
Weight *
(subject to correction)
Class *

NMFC#
* Description :
 

HAZMAT Emer. Phone #
(Please type numbers only)
Declared value:
$
Per:
Full Capacity Trailer?
Yes No
Special Instructions:
 
COD Information
COD Amount:
$
COD Fee To Be Paid By:
COD Payment Type(s):
Company Check OK Cash Or Certified Funds
Remit COD To:
Mailing Address:
City:
State:
Zip Code:
 
Guaranteed Standard
Guaranteed Hour Specific
Authorized By:

Deliver between
and
Airport Delivery Airport Pickup Appointment Canada fee going to Canada Hazardous Materials Fee Inside Delivery Inside Pickup Liftgate Delivery Collect Liftgate Delivery Prepaid Liftgate Pickup Collect Liftgate Pickup Prepaid
Limited Access Long Freight - Exceeds 15' Long Freight - Exceeds 27' Notification Prior to Delivery Residential Delivery Residential Liftgate Residential Pickup Saturday Delivery Saturday Pickup US border crossing collect US border crossing prepaid