DATE:

BILL OF LADING

PAGE 1 OF _______

SHIP FROM

Name: Address: City/State/Zip:

Bill of Lading Number:

BAR CODE SPACE

SID#:

FOB:

SHIP TO

CARRIER NAME:

Name:

Location #:

Trailer number:

Address:

Seal number(s):

City/State/Zip:

SCAC:

CID#:

FOB:

Pro number:

THIRD PARTY FREIGHT CHARGES BILL TO:

BAR CODE SPACE

Name:   Address: City/State/Zip:

Freight Charge Terms: Prepaid Collect 3rd Party

SPECIAL INSTRUCTIONS:

(check box)

Master Bill of Lading: with attached underlying Bills of Lading

CUSTOMER ORDER INFORMATION

CUSTOMER ORDER NUMBER

# PKGS

WEIGHT

PALLET/SLIP (CHECK ONE)

ADDITIONAL SHIPPER INFO

GRAND TOTAL

CARRIER INFORMATION

HANDLING UNIT

PACKAGE

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.

LTL ONLY

QTY

TYPE

QTY

TYPE

WEIGHT

H.M.

NMFC #

CLASS

RECEIVING STAMP SPACE

GRAND TOTAL

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:

COD Amount: $

"The agreed or declared value of the property is specifically stated by the shipper to be not exceeding __________________ per ___________________."

Fee Terms: Collect:   Prepaid: Customer check acceptable:

NOTE Liability Limitation for loss or damage in this shipment may be applicable. See 49 U.S.C. § 14706(c)(1)(A) 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 freight and all other lawful charges.________________________________Shipper Signature

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.

Trailer Loaded:

Freight Counted:

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.

By Shipper By Driver

By Shipper By Driver/pallets said to contain By Driver/Pieces

Shipper and/or Amark Logistics Inc. will not be responsible for additional charges or services rendered without prior written authorization by Amark Logistics Inc.