Requestor Name :  (required)
Pickup Date :  (Required)
   
Requestor Phone: (required)
Pickup Time :  (Required)
   
Requestor Email :  (required)
Closing Time : (Required)
   
Bill of Lading No :  
PO Number :  
   
Freight Charges :   PrePaid      Collect
  
FREIGHT CHARGES ARE PREPAID ON THIS BILL OF
LADING UNLESS MARKED COLLECT.
  
 
Shipper (From)
  
Consignee (To) :
  
Special Instructions :
Name : 
 
Name : 
Address 1 : 
 
Address 1 : 
Address 2 : 
 
Address 2 : 
City,St,Zip : 
 
City,St,Zip : 
             
Bill To (Payor) :
  
Remit COD To :
    
Name : 
 
Name : 
   
Address 1 : 
 
Address 1 : 
 
COD Amount : $
Address 2 : 
 
Address 2 : 
 
COD Fee :
City,St,Zip : 
 
City,St,Zip : 
 
Prepaid      Collect
             
             
# pieces
Ship type
HAZ
Description
NMFC No.
Class
weight(lbs)
             
Total Shipping Units :
Total Weight :
 
     
Hazardous Materials Emergency Contact :   
     
Carrier Liability: Shipments valued at more that $25.00 per pound are of extraordinary value. Carrier's maximum liability is $25.00 per pound per package subject to $100,000.00 maximum total liability per shipment. The agreed value on household goods, used machinery, or personal effects does not exceed ten cents per pound per article, unless otherwise specified.
  
"THIS IS TO CERTIFY THAT THE ABOVE NAMED MATERIALS ARE PROPERLY CLASSIFIED, DESCRIBED, PACKAGED, MARKED, AND LABELED AND ARE IN PROPER CONDITION FOR TRANSPORTATION ACCORDING TO THE APPLICABLE REGULATIONS OF THE DEPARTMENT OF TRANSPORTATION AND THE NATIONAL MOTOR FREIGHT CLASSIFICATION AS SHOWN IN THE NMFC 100 SERIES."
     
* Mark with an “x” to designate hazardous material as defined in the Department of Transportation regulations governing the transportation of hazardous material. The use of this column is an optional method for identifying hazardous materials on bills of lading per section 172.201(a)(1)iii of Title 49, Code of Federal Regulations. Also, when shipping hazardous materials, the shippers certification statement prescribed in section 172.204(a) of the Federal Regulations must be indicated on the bill of lading unless a specific section from this requirement is provided in the regulations for a particular material.
NOTE : Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or declared value of the property.
The agreed or declared value of the property is hereby specifically stated by the shipper to be not exceeding $ Per
     
Shipper hereby certifies that he understands that all transportation by ALCO DELIVERY shall be subject to the terms and conditions of the Bill of Lading contract shown in the NMFC 100 series, and the said terms and conditions are hereby agreed to by the shipper and accepted for himself and his assigns.
     
     
     
    
 
 
 
 
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