Vics Bill Lading – Fill Out and Use

CUSTOMER ORDER INFORMATION

CUSTOMER ORDER NUMBER

# PKGS

WEIGHT

PALLET/SLIP

ADDITIONAL SHIPPER INFO.

(CIRCLE ONE)

Y

N

Y

N

Y

N

Y

N

GRAND TOTAL

CARRIER INFORMATION

HANDLING UNIT

PACKAGE

COMMODITY DESCRIPTION

LTL ONLY

WEIGHT

H.M.

Commodities requring special or additional care or attention in handling or stowing must

QTY

TYPE

QTY

TYPE

X

be so marked and packaged as to ensure safe transportation with ordinary care.

NMFC #

CLASS

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

COD Amount: $_______________________

of the property as follows:

“The agreed or declared value of the property is specifically stated by the shipper to be not exeeding

Fee Terms: Collect

Prepaid

__________________ per _______________________.

Customer check acceptable

NOTE: Liability limitation for loss or damage in this shipment may be applicable. See 49 U.S.C. B 14706(c)(1)(A) and (B)

RECEIVED, subject to individually determined rates or contracts that have been agreed upon in writing between the

The carrier shall not make delivery of this shipment without payment of

carrier and shipper, if applicable, otherwise to the rates, classifications and rules that have been establed by the

freight and all other lawful charges.

carrier and are available to the shipper, on request, and to all applicable state and federal reguations.

_________________________________________ Shipper Signature

SHIPPER SIGNATURE / DATE

Trailer Loaded:

Freight Counted:

CARRIER SIGNATURE / PICKUP DATE

This is to certify that the above-named materials are properly classified,

By Shipper

By Shipper

Carrier acknowledges receipt of packages and required placards.

described, packaged, marked and labeled, and are in proper condition

Carrier certifies emergency response information was made available

for transportation according to the applicable regulations of the

By Driver

By Driver / pallets said to

and/or carrier has the DOT emergency response guidebook or

equivalent documentation in the vehicle.

Department of Transportation.

contain

Property described above is received in good order, except as noted.

________________________________________ __________________

By Driver/Pieces

_______________________________________ __________________

(Signature)

(Date)

(Signature)

(Date)