This form contains 87 fields organized into 24 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Billing Information
text_2d27_35c8 Text
Max length: 40 characters
text_ba26_fdb6 Text
Max length: 37 characters
text_1bf3_1ce6 Text
Max length: 40 characters
text_256d_d5be Text
Max length: 34 characters
C.O.D. Amount
COD Amount Number
Enter the total amount required for the Cash on Delivery (C.O.D.) payment.
Max length: 28 characters
C.O.D. Fee Payment Method
Prepaid Checkbox
Check this box if the C.O.D. fee will be paid in advance by the shipper. Fill only if 'COD Amount' has a non-zero value.
Depends on: COD Amount
Collect Checkbox
Check this box if the C.O.D. fee will be collected from the consignee upon delivery. Fill only if 'COD Amount' has a non-zero value.
Depends on: COD Amount
C.O.D. Remittance Information
Remit COD To Text
Please enter the name of the entity or individual to whom the C.O.D. amount is to be remitted. Fill only if 'COD Amount' has a non-zero value.
Max length: 46 characters
Depends on: COD Amount
Attention To Text
Please enter the name of the specific person or department the C.O.D. remittance should be directed to. Fill only if 'COD Amount' has a non-zero value.
Max length: 41 characters
Depends on: COD Amount
Remittance Address Text
Please enter the full mailing address for the C.O.D. remittance. Fill only if 'COD Amount' has a non-zero value.
Depends on: COD Amount
Carrier Signature
Carrier Representative Name Text
Provide the name of the carrier's representative signing the bill of lading.
Max length: 45 characters
Carrier Representative Title or Initials Text
Provide the title or initials of the carrier's representative signing the bill of lading.
Max length: 17 characters
Consignee Information
Consignee Name Text
Provide the name of the consignee.
Max length: 36 characters
Consignee Street Text
Enter the street address of the consignee.
Max length: 40 characters
Destination Text
Specify the final destination for the shipment.
Max length: 36 characters
Consignee City, State, Zip Text
Enter the city, state, and zip code for the consignee's address.
Max length: 34 characters
Route Text
Provide any specific routing instructions for the shipment.
Max length: 40 characters
Consignor's No Recourse Signature
Consignor's Signature Text
Provide the consignor's signature to indicate agreement with the no recourse statement.
Max length: 27 characters
Declared Value
Quantity Limit Number
Enter the maximum quantity of property for which the declared value is stated.
Max length: 4 characters
Declared Value Amount Number
Enter the declared monetary value per unit of the property.
Max length: 14 characters
Unit of Measure Text
Enter the unit of measure for the declared value, such as 'pound' or 'item'.
Max length: 12 characters
Eighth Shipping Item
Eighth Item Number of Shipping Units Number
Enter the number of shipping units for the eighth item.
Max length: 24 characters
Eighth Item Time Time
Enter the time related to the eighth shipping item.
Max length: 11 characters
Eighth Item Description of Articles Text
Enter the description of articles, including any special marks or exceptions, for the eighth shipping item.
Max length: 27 characters
Eighth Item Weight Number
Enter the weight of the eighth shipping item.
Max length: 8 characters
Eighth Item Rate Number
Enter the rate for the eighth shipping item.
Max length: 6 characters
Eighth Item Charges Number
Enter the total charges for the eighth shipping item.
Max length: 21 characters
Fifth Shipping Item
Number of Shipping Units Number
Enter the number of shipping units for the fifth item.
Max length: 24 characters
Time Text
Enter any relevant time information for the fifth shipping item.
Max length: 11 characters
Description of Articles and Special Marks Text
Provide a detailed description of the fifth shipping item, including any special marks or exceptions.
Max length: 27 characters
Weight Number
Enter the weight of the fifth shipping item.
Max length: 8 characters
Rate Number
Enter the rate applicable to the fifth shipping item.
Max length: 6 characters
Charges Number
Enter the total charges for the fifth shipping item.
Max length: 21 characters
First Shipping Item
Number of Shipping Units Number
Enter the total number of shipping units for this item.
Max length: 24 characters
Time Time
Enter the time associated with this shipping item.
Max length: 11 characters
Description of Articles and Exceptions Text
Provide a detailed description of the articles being shipped, including any special marks or exceptions.
Max length: 27 characters
Weight Number
Enter the total weight of this shipping item.
Max length: 8 characters
Rate Number
Enter the shipping rate for this item.
Max length: 6 characters
Charges Number
Enter the total charges for this shipping item.
Max length: 21 characters
Fourth Shipping Item
Number of Shipping Units Number
Enter the number of shipping units for this item.
Max length: 24 characters
Shipping Time Time
Enter the time related to this shipping item.
Max length: 11 characters
Article Description and Exceptions Text
Provide a detailed description of the articles being shipped, including any special marks or exceptions.
Max length: 27 characters
Weight Number
Enter the total weight of this shipping item.
Max length: 8 characters
Rate Number
Enter the rate applied to this shipping item.
Max length: 6 characters
Charges Number
Enter the total charges for this shipping item.
Max length: 21 characters
Freight Charge Payment
Market Prepaid Amount Number
Please enter the market prepaid amount for the freight charges.
Max length: 17 characters
Freight Charges Prepaid Checkbox
Check this box if the freight charges for the shipment have been paid in advance. Fill only if 'Market Prepaid Amount' is 'Yes'.
Depends on: Market Prepaid Amount
Receipt Confirmation Notes
Declared Value Limit Number
Enter the maximum monetary value that the property is declared not to exceed.
Second Shipping Item
Second Shipping Item Units Number
Enter the number of shipping units for the second item.
Max length: 24 characters
Second Shipping Item Time Time
Enter the time associated with the second shipping item.
Max length: 11 characters
Second Shipping Item Description Text
Provide a detailed description of the second shipping item, including any special marks or exceptions.
Max length: 27 characters
Second Shipping Item Weight Number
Enter the total weight of the second shipping item.
Max length: 8 characters
Second Shipping Item Rate Number
Enter the applicable shipping rate for the second item.
Max length: 6 characters
Second Shipping Item Charges Number
Enter the total charges for the second shipping item.
Max length: 21 characters
Seventh Shipping Item
Seventh Shipping Item Number of Units Text
Enter the number of shipping units for the seventh item.
Max length: 24 characters
Seventh Shipping Item Time Time
Enter the time related to the seventh shipping item.
Max length: 11 characters
Seventh Shipping Item Description Text
Provide a detailed description of the seventh shipping item, including any special marks or exceptions.
Max length: 27 characters
Seventh Shipping Item Weight Number
Enter the total weight of the seventh shipping item.
Max length: 8 characters
Seventh Shipping Item Rate Number
Enter the shipping rate for the seventh item.
Max length: 6 characters
Seventh Shipping Item Charges Number
Enter the total charges for the seventh shipping item.
Max length: 21 characters
Shipment Identification
Trailer/Car Number Text
Please provide the identifying number for the trailer or car used in the shipment.
Max length: 17 characters
Bill Date Date
Please enter the date the bill of lading was issued.
Max length: 16 characters
Shipper Information
Shipper Name Text
Please enter the full name of the shipper or the shipping company.
Max length: 42 characters
Shipper Street Text
Please enter the street address of the shipper.
Max length: 43 characters
Origin Location Text
Please enter the specific location or facility name from which the shipment originates.
Max length: 43 characters
Origin City, State, Zip Text
Please enter the city, state, and zip code for the shipment's origin location.
Max length: 37 characters
Shipper Special Instructions Text
Please enter any special handling or delivery instructions provided by the shipper.
Max length: 31 characters
Shipper Signature
Shipper Signature Text
Please enter the signature or printed name of the shipper.
Max length: 45 characters
Shipper Title Text
Please enter the title or role of the person signing on behalf of the shipper.
Max length: 48 characters
Shipper's Instructions
Instruction Line 1 Text
Please enter the first line of specific instructions provided by the shipper.
Max length: 50 characters
Instruction Line 2 Text
Please enter the second line of specific instructions provided by the shipper.
Max length: 50 characters
Instruction Line 3 Text
Please enter the third line of specific instructions provided by the shipper.
Max length: 50 characters
Instruction Line 4 Text
Please enter the fourth line of specific instructions provided by the shipper.
Max length: 50 characters
Signature Date
Signature Date Date
Please provide the date of the signature for the Bill of Lading.
Max length: 23 characters
Sixth Shipping Item
Sixth Item Number of Shipping Units Number
Enter the number of shipping units for the sixth item.
Max length: 24 characters
Sixth Item Time Time
Enter the time related to the sixth shipping item.
Max length: 11 characters
Sixth Item Description and Special Marks Text
Provide a detailed description of the sixth article, including any special marks or exceptions.
Max length: 27 characters
Sixth Item Weight Number
Enter the weight of the sixth shipping item.
Max length: 8 characters
Sixth Item Rate Number
Enter the shipping rate for the sixth item.
Max length: 6 characters
Sixth Item Charges Number
Enter the total charges for the sixth shipping item.
Max length: 21 characters
Third Shipping Item
Number of Shipping Units Number
Enter the total number of shipping units for this item.
Max length: 24 characters
Time Time
Enter the time related to this item.
Max length: 11 characters
Description of Articles Text
Provide a detailed description of the articles being shipped, including any special marks or exceptions.
Max length: 27 characters
Weight Number
Enter the weight of this shipping item.
Max length: 8 characters
Rate Number
Enter the applicable shipping rate for this item.
Max length: 6 characters
Charges Number
Enter the total charges for this shipping item.
Max length: 21 characters
Total Charges
Total Charges Amount Number
Enter the total amount of charges for the shipment.