Fedex Bill Of Lading Form

Date

Purchase Order #

Shipper #

Shipper #

REQUIRED: Please select a service type

OPTIONAL: You may select a money-back guarantee

q

FedEx Freight

®

Priority

delivery (charges and tariff limitations may apply).

q A.M. Delivery q Close of Business Delivery

q FedEx Freight® Economy

SHIPPER (from)

Please provide ZIP codes and phone numbers.

CONSIGNEE (to)

Shipper

FXF Acct. #

Consignee

FXF Acct. #

Attn. to

Area Code

Phone Number

Attn. to

Area Code

Phone Number

Address

Address

Address (Store, Dept., Ste., Flr., Apt., Div.)

Address (Store, Dept., Ste., Flr., Apt., Div.)

Address

Address

City

City

State/Province

ZIP/Postal Code

Country

State/Province

ZIP/Postal Code

Country

Optional or Additional Service Fees and Charges rLiftgate rInside Pickup rLimited Access

Optional or Additional Service Fees and Charges rLiftgate rInside Delivery rLimited Access

Shipper Bill of Lading #

rCustom Delivery Window:

Special Instructions

BILL FREIGHT CHARGES TO (if different than above):

Name

FXF Acct. #

Mailing Address

City

State

ZIP/Postal Code

Country

Area Code

Phone Number

Freight charges are PREPAID unless

USD

C.O.D.

1.

The letters

“C.O.D.” must appear

in box before consignee’s name above.

marked collect.

2.

C.O.D. funds to be collected as:

 Certified Funds  Company Check

Personal Check

CAD

CHECK BOX IF COLLECT 

AMOUNT

3.

C.O.D. fee to be paid by:  Shipper  Consignee

Name

Mailing Address

City

State

ZIP/Postal Code

Country

Country Code

Area Code

Phone Number

HANDLING H/U PKG.

PIECES

HM

KIND OF PACKAGE, DESCRIPTION OF ARTICLES, SPECIAL MARKS AND EXCEPTIONS

WEIGHT IN LBS.

NMFC ITEM #

CLASS

CUBE

(optional)

UNITS (H/U) TYPE

(X)

(subject to correction)

(subject to correction)

TOTAL H/U:

H MARK “X” OR “RQ” IN THE HM COLUMN TO DESIGNATE HAZARDOUS MATERIALS OR REPORTABLE QUANTITY AS DEFINED IN DOT REGULATIONS.

FOR INTERNATIONAL SHIPMENTS INDICATE BROKER NAME, FAX AND PHONE NUMBERS.

area code

HM EMERGENCY CONTACT PHONE NUMBER (_______) ______________________

EEI/SED Number or Exception______________________________________

AREA CODE

CUSTOMER REGISTERED W/EMERGENCY RESPONSE INFO. PROVIDER or CONTRACT #

Phone # (_______) ___________________

___________________________________________________________________

Broker Name______________________________________________________

AREA CODE

Fax # (_______) _____________________

NOTE (1) Where the rate and carrier’s liability for loss or damage may be dependent on value, shippers

FOR FREIGHT COLLECT SHIPMENTS

must state specifically in writing the agreed or declared value of the property as follows: “The agreed

Subject to Section 7 of conditions of applicable Bill of Lading. If this shipment is to be delivered to the consignee,

or declared value of the property is specifically stated by the shipper to be not exceeding________

per_________.”

without recourse on the consignor, the consignor shall sign the following statement. The carrier may decline to

Note(2)liabilitylimitationforlossordamageonthisshipmentshallbeapplicableasprovidedbycontract

make delivery of this shipment without payment of freight and all other lawful charges.

or in the current NMFC or this carrier’s governing tariffs. See FXF 100 Series Rules Tariff for complete

Consignor Signature____________________________________________________________________________________________

limited liability provisions. Carrier’s maximum standard liability is limited to $25 per pound per package

for NEW articles and $.50 per pound per package (or its equivalent in Mexican Pesos (MXN) or Canadian

SHIPPER CERTIFICATION

Dollars(CAD),attherateofexchangewhichisineffectattheplaceandonthedateofshipment)for USED

Iherebydeclarethatthecontentsofthisconsignmentarefullyandaccuratelydescribedabovebythepropershipping

orRECONDITIONEDarticles. Innocaseshallcarrierliabilityexceed$100,000peroccurrence(oritsequivalent

name, and are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for

inMXNorCADattherateofexchangewhichisineffectattheplaceandonthedateofshipment) for NEW

articlesor$10,000peroccurrence(oritsequivalentinMXNorCADattherateofexchangewhichisineffect

transport according to applicable international and national governmental regulations.

at the place and on the date of shipment) for USED or RECONDITIONED articles. For availability and limits

Shipper Signature___________________________________________________________________ Date_____________________

of excess liability coverage and applicable rates and charges, please refer to FXF 100 Series Rules Tariff. Not

selecting an additional coverage option is considered to be a waiver of same and standard liability coverage

CARRIER CERTIFICATION

willapply.

Carrier acknowledges receipt of packages and required placards. Carrier certifies emergency response information

 ArticlesareNEW,andrequireExcessLiabilityCoverageintheamountof_______________

wasmadeavailableand/orcarrierhastheDOTemergencyresponseguidebookorequivalentdocumentinthevehicle.

oUSD oCAD oMXNper olb. orokg.Additionalchargeswillapply.

 ArticlesareUSEDorRECONDITIONEDandrequire ExcessLiabilityCoverage.Additionalchargeswillapply.

DATE

DRIVER/EMPLOYEE NUMBER

PIECE COUNT

TRAILER #

NOTE (3) Commodities requiring special or additional care or attention in handling or stowing must be so

markedandpackagedastoensuresafetransportationwithordinarycare.SeeSec.2(e)ofNMFCItem360.

Create your next Bill of Lading online at fedex.com/us/freight/main/

FedEx Freight

CO202/518-FXF 0023776PM