Bill of Lading  

Please complete all information: 
Date: 11/19/2017
 
  Consignee Information
Name    Phone  () -   Ext.
Address    Email 
   
City, State, Zip       
Attention   
 
  Shipper Information
Name    Phone  () -   Ext.
Address    Email 
    Haz-Mat
Phone 
() -
City, State, Zip       
 
  Bill To Information
 
Name 
Address 
City, State, Zip   
Phone  () -
 
  Other Information
 
SHIPPERS NO. 
PTLS PRO NUMBER 
QUOTE NO. 
Declared Value
$ per 
  Special Instructions
 
  Line Items
NMFC Item No.  Package Type  HazMat    Description of Articles, Special Marks, and Exceptions
 
     Bulk       Pieces  Class  Weight   
     
All line items must be entered in the below list.
Bulk Pieces Pkg Type HM NMFC Item No. Description Class Weight