This form contains 77 fields organized into 23 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Bill To Information
Bill To Name	Text	Please provide the full name of the entity or person responsible for payment. Fill only if '3rd Party (See Bill To)' is 'Yes'. Max length: 45 characters Depends on: 3rd Party (See Bill To)
Bill To Address	Text	Please provide the street address for the billing entity. Fill only if '3rd Party (See Bill To)' is 'Yes'. Max length: 42 characters Depends on: 3rd Party (See Bill To)
Bill To City	Text	Please provide the city for the billing address. Fill only if '3rd Party (See Bill To)' is 'Yes'. Max length: 12 characters Depends on: 3rd Party (See Bill To)
Bill To Province/State	Text	Please provide the province or state for the billing address. Fill only if '3rd Party (See Bill To)' is 'Yes'. Max length: 30 characters Depends on: 3rd Party (See Bill To)
Bill To Postal Code/Zip	Text	Please provide the postal code or ZIP code for the billing address. Fill only if '3rd Party (See Bill To)' is 'Yes'. Max length: 41 characters Depends on: 3rd Party (See Bill To)
C.O.D. Amount
C.O.D. Amount	Number	Provide the total Collect on Delivery (C.O.D.) amount for the shipment. Max length: 11 characters
Carrier Acceptance
Driver ID	Text	Please enter the identification number of the driver. Max length: 10 characters
Carrier ID	Text	Please enter the identification number of the carrier. Max length: 15 characters
Accepted Pieces Quantity	Number	Please enter the total number of pieces accepted by the carrier. Max length: 9 characters
Acceptance Date	Date	Please enter the date when the carrier accepted the shipment. Max length: 17 characters
Carrier Internal Use
Carrier Security Signature Identifier (Outbound)	Text	Enter the identification or initials of the carrier's security signatory responsible for the outbound process. Max length: 14 characters
External Unit Reference Number	Text	Enter the external unit reference number used for this shipment within the carrier's system. Max length: 14 characters
Pieces To Dock Count	Number	Enter the total number of pieces that were moved to the dock. Max length: 12 characters
Internal Checker Identifier (Dock-In)	Text	Enter the identification or initials of the internal checker responsible for logging pieces onto the dock. Max length: 12 characters
Carrier Security Signature Identifier (Inbound)	Text	Enter the identification or initials of the carrier's security signatory responsible for the inbound process. Max length: 12 characters
Pieces Ex-Dock Count	Number	Enter the total number of pieces that were moved off the dock. Max length: 13 characters
Internal Destination Unit Number	Text	Enter the internal unit number designated for the shipment's destination within the carrier's operations. Max length: 12 characters
Internal Checker Identifier (Dock-Out)	Text	Enter the identification or initials of the internal checker responsible for logging pieces off the dock. Max length: 12 characters
Consignee Information
Consignee Name	Text	Please enter the full name of the consignee. Max length: 42 characters
Consignee Address	Text	Please enter the street address of the consignee. Max length: 45 characters
Consignee City	Text	Please enter the city for the consignee's address. Max length: 23 characters
Consignee Province/State	Text	Please enter the province or state for the consignee's address. Max length: 20 characters
Consignee Postal/Zip Code	Text	Please enter the postal code or zip code for the consignee's address. Max length: 9 characters
Consignee Phone Number (Line Number)	Text	Please enter the line number part of the consignee's telephone number. Max length: 16 characters
Consignee Reference Number	Text	Please enter the consignee's reference number. Max length: 35 characters
Consignee Phone Number (Area Code)	Text	Please enter the area code part of the consignee's telephone number. Max length: 2 characters
Consignee Phone Number (Prefix)	Text	Please enter the prefix part of the consignee's telephone number. Max length: 1 characters
Date Shipped
Shipment Year	Date	Please enter the year the shipment was dispatched. Max length: 4 characters
Shipment Month	Date	Please enter the month the shipment was dispatched. Max length: 5 characters
Shipment Day	Date	Please enter the day of the month the shipment was dispatched. Max length: 1 characters
Declared Valuation
Declared Valuation Amount	Number	Enter the declared monetary value of the shipment for liability purposes. Max length: 14 characters
Eighth Goods Row
Eighth Row Number of Pieces	Number	Enter the total number of pieces for the goods described in the eighth row. Max length: 14 characters
Eighth Row Goods Description	Text	Provide a detailed description of the goods, including any special marks or cube information, for the eighth row. Max length: 83 characters
Eighth Row Weight in LBS	Number	Enter the total weight of the goods in pounds for the eighth row. Max length: 15 characters
Fifth Goods Row
Fifth Row Number of Pieces	Number	Enter the number of pieces for the fifth row of goods listed. Max length: 14 characters
Fifth Row Goods Description	Text	Provide a detailed description of the goods, any special marks, and the cube for the fifth row of items. Max length: 83 characters
Fifth Row Weight (LBS)	Number	Enter the weight in pounds for the fifth row of goods listed. Max length: 15 characters
First Goods Row
Number of Pieces	Number	Enter the number of pieces for the first row of goods. Max length: 14 characters
Description of Goods	Text	Provide a detailed description of the goods, including any special marks or cube information, for the first row. Max length: 84 characters
Weight in LBS	Number	Enter the weight of the goods in pounds for the first row. Max length: 15 characters
Fourth Goods Row
Fourth Row Number of Pieces	Number	Enter the total number of individual items or pieces for the fourth line item of goods. Max length: 14 characters
Fourth Row Goods Description	Text	Provide a detailed description of the goods, including any special marks or cubic measurements, for the fourth line item. Max length: 83 characters
Fourth Row Weight (LBS)	Number	Enter the total weight in pounds for the fourth line item of goods. Max length: 15 characters
Freight Charges
Prepaid	Checkbox	Check this box if the freight charges for this shipment 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 of the goods.
3rd Party (See Bill To)	Checkbox	Check this box if a third party, specified in the 'Bill To' section, is responsible for paying the freight charges.
Goods Totals
Total Number of Pieces	Number	Please enter the total number of pieces being shipped. Max length: 46 characters
Total Weight	Number	Please enter the total weight of all goods in pounds. Max length: 15 characters
Ninth Goods Row
Total Number of Pieces	Number	Please provide the total number of pieces for all goods included in the shipment. Max length: 14 characters
Total Goods Description and Remarks	Text	Please provide any final description, special marks, or cube information for the total goods. Max length: 83 characters
Total Weight	Number	Please provide the total weight in pounds for all goods in the shipment. Max length: 15 characters
Print Name
Printed Name	Text	Please enter the printed name of the person making the declaration. Max length: 27 characters
Second Goods Row
Second Row Number of Pieces	Number	Enter the total number of pieces for the second item listed. Max length: 14 characters
Second Row Goods Description	Text	Provide a detailed description of the goods, including any special marks or cubic measurements for the second item. Max length: 84 characters
Second Row Weight (LBS)	Number	Enter the total weight in pounds for the second item listed. Max length: 15 characters
Seventh Goods Row
Seventh Row Number of Pieces	Number	Enter the number of pieces for the seventh row of goods. Max length: 14 characters
Seventh Row Description of Goods	Text	Provide a detailed description of the goods, special marks, and cube for the seventh row. Max length: 83 characters
Seventh Row Weight (LBS)	Number	Enter the weight of the goods in pounds for the seventh row. Max length: 15 characters
Shipper Information
Shipper Name	Text	Enter the full name of the shipper. Max length: 43 characters
Shipper Address	Text	Enter the street address of the shipper. Max length: 43 characters
Shipper Province	Text	Enter the province of the shipper. Max length: 22 characters
Shipper City	Text	Enter the city of the shipper. Max length: 18 characters
Shipper Postal Code/Zip	Text	Enter the postal code or zip code of the shipper. Max length: 10 characters
Shipper Phone Number Line Number	Text	Enter the four-digit line number of the shipper's telephone number. Max length: 12 characters
Shipper's Reference Number	Text	Enter the shipper's internal reference number for this shipment. Max length: 38 characters
Shipper Phone Number Prefix	Text	Enter the three-digit prefix of the shipper's telephone number. Max length: 1 characters
Shipper Phone Number Area Code	Text	Enter the area code of the shipper's telephone number. Max length: 2 characters
Shipper Signature
Shipper Declared Quantity	Number	Enter the quantity of goods declared by the shipper for valuation purposes. Max length: 26 characters
Shipper Declared Unit of Measure	Text	Enter the unit of measure corresponding to the declared quantity of goods (e.g., LBS, PCS). Max length: 27 characters
Sixth Goods Row
Sixth Row Number of Pieces	Number	Please enter the number of pieces for the sixth row of goods. Max length: 14 characters
Sixth Row Description of Goods	Text	Please provide a detailed description of the goods, including any special marks and cube, for the sixth row. Max length: 83 characters
Sixth Row Weight (LBS)	Number	Please enter the weight in pounds (LBS) for the sixth row of goods. Max length: 15 characters
Special Instructions
Special Instructions	Text	Provide any specific instructions or additional details relevant to the shipment or delivery.
Tenth Goods Row
Total Number of Pieces	Number	Enter the total number of pieces for all goods listed in the consignment. Max length: 14 characters
Third Goods Row
Third Row Number of Pieces	Number	Enter the number of individual items or pieces for this goods entry. Max length: 14 characters
Third Row Goods Description	Text	Provide a detailed description of the goods, any special marks, and their cubic dimensions for this entry. Max length: 83 characters
Third Row Weight (LBS)	Number	Enter the total weight of the goods in pounds for this entry. Max length: 15 characters

Uniform Straight Bill of Lading Instructions