This form contains 78 fields organized into 16 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Bill of Lading Details
BOL Number Text
Provide the Bill of Lading (BOL) number for this shipment.
Max length: 15 characters
Vehicle Number Text
Provide the identification number of the vehicle used for this shipment.
Max length: 12 characters
Date Date
Enter the date on which this Bill of Lading was issued.
Max length: 12 characters
Carrier Number Text
Enter the identification number of the carrier handling this shipment.
Max length: 11 characters
Billing Information
text_3aef_fcb0 Text
Max length: 35 characters
Depends on: Third Party
text_c2b5_476e Text
Max length: 35 characters
Depends on: Third Party
text_6946_4c96 Text
Max length: 35 characters
Depends on: Third Party
text_a380_3e78 Text
Max length: 15 characters
Depends on: Third Party
text_eaba_7967 Text
Max length: 12 characters
Depends on: Third Party
Consignee Information
Consignee Company Text
Enter the legal name of the consignee's company.
Max length: 41 characters
Consignee Address Text
Provide the street address for the consignee.
Max length: 41 characters
Consignee City Text
Enter the city where the consignee is located.
Max length: 41 characters
Consignee State Text
Enter the state where the consignee is located.
Max length: 14 characters
Consignee ZIP Code Text
Enter the postal ZIP code for the consignee's address.
Max length: 19 characters
Consignee Phone Number Text
Enter the primary phone number for the consignee.
Max length: 14 characters
Consignee Fax Number Text
Enter the fax number for the consignee, if applicable.
Max length: 19 characters
Consignee Contact Name Text
Enter the name of the primary contact person at the consignee's company.
Max length: 35 characters
Declared Value
Declared Value Per Pound Number
Provide the declared value of the property in dollars per pound for each distribution package.
Max length: 4 characters
Delivery Acknowledgement
Consignee Name Text
Please enter the full name of the consignee.
Max length: 36 characters
Consignee Signature Text
Please provide the signature of the consignee acknowledging receipt.
Max length: 36 characters
Exceptions Text
Please list any exceptions or discrepancies observed during delivery.
Fifth Item Details
Item Description Text
Please enter a detailed description of the item being shipped.
Max length: 52 characters
Freight Class Text
Please enter the freight class for this item.
Max length: 11 characters
Item Weight Number
Please provide the total weight of this item.
Max length: 9 characters
Item Rate Number
Please provide the shipping rate for this item.
Max length: 10 characters
Hazardous Material Checkbox
Check this box if the fifth item in the shipment is a hazardous material.
Number of Packages/Units Number
Please provide the total number of packages or units for this item.
Max length: 7 characters
First Item Details
Packages or Units Quantity Number
Enter the total number of packages or units for this item.
Max length: 7 characters
Item Description Text
Provide a detailed description of the item being shipped.
Max length: 52 characters
Freight Class Text
Enter the freight classification code for this item.
Max length: 11 characters
Item Weight Number
Enter the total weight of this item.
Max length: 9 characters
Shipping Rate Number
Enter the applicable shipping rate for this item.
Max length: 10 characters
HAZMAT* Checkbox
Check this box if the first item listed in the 'DESCRIPTION' column is a hazardous material.
Fourth Item Details
Fourth Item Packages/Units Number
Provide the total number of packages or units for the fourth item in the shipment.
Max length: 7 characters
Fourth Item Description Text
Provide a detailed description of the fourth item being shipped.
Max length: 52 characters
Fourth Item Class Text
Enter the freight class code for the fourth item in the shipment.
Max length: 11 characters
Fourth Item Weight Number
Provide the total weight of the fourth item in the shipment.
Max length: 9 characters
Fourth Item Rate Number
Enter the shipping rate for the fourth item in the shipment.
Max length: 10 characters
Fourth Item HAZMAT Checkbox
Check this box if the fourth item listed is a Hazardous Material as defined by the Department of Transportation Regulations.
Freight Charges
Prepaid Checkbox
Check this box if the freight charges have been paid in advance by the shipper.
Collect Checkbox
Check this box if the freight charges are to be collected from the consignee upon delivery.
Third Party Checkbox
Check this box if a third party, other than the shipper or consignee, is responsible for paying the freight charges.
Consignor Freight Payment Signature Text
Provide the signature of the consignor to acknowledge the freight payment terms as described in Section 7.
Max length: 23 characters
General
text_d4b9_0724 Text
Max length: 36 characters
text_15d2_a9a2 Text
Max length: 36 characters
Second Item Details
Second Item Packages/Units Number
Enter the total number of packages or units for the second item.
Max length: 7 characters
Second Item Description Text
Enter a detailed description of the second item being shipped.
Max length: 52 characters
Second Item Class Text
Enter the freight class for the second item.
Max length: 11 characters
Second Item Weight Number
Enter the weight of the second item.
Max length: 9 characters
Second Item Rate Number
Enter the shipping rate for the second item.
Max length: 10 characters
Hazmat - Second Item Checkbox
Check this box if the second item listed on the bill of lading is a hazardous material.
Seventh Item Details
Seventh Item Packages/Units Number
Enter the total number of packages or units for the seventh item being shipped.
Max length: 7 characters
Seventh Item Description Text
Provide a detailed description of the seventh item being shipped.
Max length: 52 characters
Seventh Item Class Number
Enter the freight class of the seventh item.
Max length: 11 characters
Seventh Item Weight Number
Enter the total weight of the seventh item.
Max length: 9 characters
Seventh Item Rate Number
Enter the shipping rate for the seventh item.
Max length: 10 characters
HAZMAT Checkbox
Check this box if the seventh item described is a hazardous material.
Shipper Information
Shipper Company Text
Enter the name of the shipper's company.
Max length: 42 characters
Shipper Address Text
Enter the full street address of the shipper.
Max length: 42 characters
Shipper City Text
Enter the city where the shipper is located.
Max length: 42 characters
Shipper State Text
Enter the state where the shipper is located.
Max length: 14 characters
Shipper ZIP Code Text
Enter the postal ZIP code for the shipper's address.
Max length: 19 characters
Shipper Phone Text
Enter the primary phone number for the shipper.
Max length: 14 characters
Shipper Fax Text
Enter the fax number for the shipper.
Max length: 19 characters
Shipper Contact Name Text
Enter the name of the primary contact person for the shipper.
Max length: 36 characters
Sixth Item Details
Packages or Units Number
Enter the total number of packages or units for this item.
Max length: 7 characters
Item Description Text
Provide a detailed description of the item being shipped.
Max length: 52 characters
Freight Class Number
Enter the freight class applicable to this item.
Max length: 11 characters
Item Weight Number
Enter the total weight of this item.
Max length: 9 characters
Shipping Rate Number
Enter the applicable shipping rate for this item.
Max length: 10 characters
Hazardous Material Checkbox
Check this box if the sixth item listed is a hazardous material as defined by the Department of Transportation Regulations.
Special Instructions
Special Instructions Text
Enter any special instructions for the shipment.
Third Item Details
Packages/Units Number
Enter the number of packages or units for the third item.
Max length: 7 characters
Description Text
Provide a detailed description of the third item being shipped.
Max length: 52 characters
Class Text
Enter the freight class for the third item.
Max length: 11 characters
Weight Number
Enter the total weight of the third item.
Max length: 9 characters
Rate Number
Enter the applicable freight rate for the third item.
Max length: 10 characters
Hazardous Material (Third Item) Checkbox
Check this box if the third item listed in the 'PKGS/UNITS' and 'DESCRIPTION' section is a hazardous material.