Bill of Lading – Short Form

     Bill of Lading No.

11340 State Route 149

P.O. Box 485                                                                                                               

Fort Ann, NY  12827

Ph: 800-336-7826  Fax: 518-639-8501                                                   

                                                                                                  Date

SHIP From

PRO STICKER

Ship To

Third Party Freight Charges Bill to

 Freight Charge Terms

  Master bill of lading with attached underlying bills of lading.

Package

LTL Only

Handling Unit

Qty

Type

Weight

HZD

MAT

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

NMFC No.

Class

Total Weight

 COD Amount: $ _______________________________________________

 Fee terms:   Collect      Prepaid    

 Customer check acceptable

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 _______________.

Note: Liability limitation for loss or damage in this shipment may be applicable. See 49 USC § 14706(c)(1)(A) and (B).

 Signature of Consignor 

 _____________________________________

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.

 Carrier Signature/Pickup Date

__________________________________________

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.

Shipper Signature/Date

___________________________________________

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.