✪
Mark “X” to designate Hazardous Materials as defined in DOT Regulations.
NOTE (1) 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 ________________________ .
NOTE (2) Liability Limitation for loss or damage on this shipment may be applicable. See 49 U.S.C. § 14706(c)(1)(A) and (B).
NOTE (3) 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 Sec. 2(e) of NMFC Item 360.
RECEIVED, subject to individually determined rates or contracts that have been agreed upon in writing between the carrier and, as applicable, shipper or consignee, otherwise to the rates, classifications and rules that
have been established by the carrier and are available to the shipper or consignee, on request; the property described above, in apparent good order, except as noted (contents and condition of contents of packages
unknown) marked, consigned, and destined as shown above, which said carrier agrees to carry to destination, if on its route, or otherwise to deliver to another carrier on the route to destination. It is mutually agreed, as
to each carrier of all or any of said property over all or any portion of said route to destination, and as to each party at any time interested in all or any of said property, that every service to be performed hereunder shall
be subject to all the terms and conditions of the Uniform Bill of Lading set forth in the National Motor Freight Classification 100-X and successive issues. The shipper or consignee hereby certifies that he is familiar with
all the terms and conditions of the said bill of lading and the said terms and conditions are hereby agreed to by the shipper and accepted for himself and his assigns.
Received $ __________________________
to apply in prepayment of the charges on the
property described hereon.
Agent or Cashier
Per ________________________________
(The Signature here acknowledges only the
amount prepaid.)
Charges Advanced:
$ __________________________________
This is to certify that the above named
materials are properly classified, described,
packaged, marked and labeled, and are in
proper condition for transportation, accord-
ing to the applicable regulations of the
Department of Transportation.
X
COD CANNOT EXCEED $20,000.00
SHIPPER (FROM) CONSIGNEE (TO)
SHIPPER:
CORPORATE OFFICE
P.O. BOX 1691 • COLUMBIA, S.C. 29202
PHONE (803) 794-7300 • www.sefl.com
SEFL FED. ID #57-0301199
DATE SHIPPED SHIPPER NUMBER PURCHASE ORDER NUMBER
NAME
STREET
CITY STATE OR PROVINCE ZIP
ISLAND OR COUNTRY PHONE
BILL TO IF DIFFERENT FROM ABOVE MAILING
ADDRESS
NAME
CITY STATE
ROUTING
INSTRUCTIONS:
SEFL
PHONE
24 HOUR EMERGENCY RESPONSE NUMBER
ORIGINAL SHORT FORM
●
NOT NEGOTIABLE
●
STRAIGHT BILL OF LADING
()
1. REMIT C.O.D. TO: (IF DIFFERENT THAN SHIPPER ABOVE)
NAME
STREET
CITY
STATE ZIP
COD
$
2. ALL CARTONS MUST BE STAMPED OR
MARKED WITH THE LETTERS “C.O.D.”
3. SHIPPER SELECT:
CASHIER’S CHECK CONSIGNEE’S CHECK “OK”
4. C.O.D. FEE: PREPAID OR: COLLECT
X
(AMOUNT) SHIPPER SIGNATURE
Number of
Packages
Kind of Package, Description of Articles
Special Marks, and Exceptions
If this shipment is to be delivered to the consignee,
without recourse on the consignor, the consignor shall
sign the following statement:
The carrier may decline to make delivery of this ship-
ment without payment of freight and all other lawful
charges.
(Signature of Consignor)
CUSTOMER COPY
●
FOR MORE ACCURATE RATING PROVIDE ZIP CODES
●
MARK HM COLUMN FOR HAZARDOUS MATERIALS
●
FREIGHT CHARGES ARE TO BE PREPAID EXCEPT WHEN COLLECT BOX BELOW IS CHECKED
THE RELIZON COMPANY
FREIGHT CHARGES
ARE PREPAID UNLESS
MARKED COLLECT
CHECK BOX IF
COLLECT
()
NAME
STREET
CITY STATE OR PROVINCE ZIP
ISLAND OR COUNTRY PHONE
()
✪
HM
