Bill of Lading - Not Negotiable DISCOIN CORP
Ph: 305.718.4446 Fax: 786.567.6008
MC 616631 DOT 1462735



Ship From

Bill of Lading Number:

Bar Code Space

Ship To

Carrier Name:

Trailer number:   


Serial number(s):

Third Party Freight Charges Bill to


Pro Number:

Bar Code Space


Special Instructions:

Freight Charge Terms (Freight charges are prepaid unless marked otherwise):

Prepaid Collect 3rd Party

Master bill of lading with attached underlying bills of lading.

Customer Order Information

Customer Order No.

# of Packages


(circle one)

Additional Shipper Information



Grand Total




Carrier Information

Handling Unit



LTL Only







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. See Section 2(e) of NMFC item 360

















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: “The agreed or declared value of the property is specifically stated by the shipper to be not exceeding _______________ per _______________.

COD Amount: $

Fee terms: Collect Prepaid Customer check acceptable

Note: Liability limitation for loss or damage in this shipment may be applicable. See 49 USC § 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.

Consignee Signature: Date & Time:



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:

q By shipper

q By driver

Freight Counted:

q By shipper

q By driver/pallets said to contain

q By driver/pieces

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. Property described above is received in good order, except as noted.