HTML Preview Sample Bill Of Lading page number 1.
ESTIMATES: Customer must initial one option.
I understand this shipment is moving under a binding estimate and
that I will be required to pay the amount shown on the estimate.
I understand this shipment is moving under a non-binding estimate.
If the charges shown on the bill of lading exceed the charges on the nonbind-
ing estimate given me by the carrier, the carrier must release the shipment to
me upon payment of no more that 110% of the estimated charges and will
extend credit for at least 30 days in which I must pay the remainder due. In
no case will I be required to pay more than 125% of the estimate (plus any
supplemental).
Customer Release: I have read and understand this contract, and release
my household goods to the carrier subject to the terms and conditions
of this contract.
Signature of Customer Date
Signature of Carrier Representative Date
STORAGE - If shipment will be placed into storage, the customer must initial
options selected.
Storage in Transit:
Shipment is to be placed in storage for a period of 90 days or less.
I understand that on the 91st day of storage the shipment becomes permanent
storage.
Permanent Storage:
e storage location will be at
Shipment is to be placed in storage for more than 90 days.
Storage In-Vehicle:
I certify that I have requested Storage-in-Vehicle for a period of
days at an agreed upon rate of $ per day.
Signature of Customer
Unit Rate Total
Storage In Transit lbs Net
Whse Handling lbs Cwt
Add'l Valuation $ at Cwt
Total storage charges $
MILEAGE RATED MOVES:
Mileage
Gross Weight (lbs)
Tare Weight
Rate
Other
Total Charges
PACKING Materials, Additional Services, Describe:
# of units
at per unit
at per unit
at per unit
at per unit
at per unit
at per unit
Total Packing Charges
OTHER CHARGES
at per unit
at per unit
at per unit
at per unit
at per unit
Total Other Charges
MOVING, PACKING, MATERIALS, STORAGE CHARGES:
Transportation Charges
Storage
Valuation
Packing Materials
Total Moving Charges
Total Amount Paid
Balance Due
Customer: is bill of lading establishes a contract between you and the household goods carrier. It conrms instructions and authorizes
the carrier to move, pack, store, and/or perform services shown. Before you sign this document it is important that you rst read
the document, including the back, and that you ask for an explanation of anything that is not clear or is dierent from any previous
information received from the carrier or carrier's representatives. is contract is subject to conditions on the back of this form.
Origin Address
Customer
Phone Cell
Email
Additional Stops
Billing Address
Destination Address
Name of Consignee (if dierent)
Phone
Other
Uniform Household Goods Bill of Lading
Hourly Rated Moves
Date Vans Personnel Start Arrive Breaks Depart End Total Hrs. Rate Charges
Customer acknowledges carrier delivered goods:
Customer Signature Date
LOSS AND DAMAGE PROTECTION (Valuation): Customer must select
and initial only one of the following options:
Basic Value Protection I release this shipment to a value of 60 cents
per pound per article, at no cost to me. is means I will be paid 60 cents
per pound for the net weight of the lost or damaged item, regardless of the
actual value of the item.
Replacement Cost Coverage with deductible which includes a
$300 deductible paid by me. is option will cost $ . e value
I declare must be at least $5.00 times the net weight of the shipment.
Replacement Cost Coverage with no deductible at a cost of
$ . e value I declare must be at least $5.00 times the net weight
of the shipment.
I declare a lump-sum total dollar valuation on this entire shipment of
$ .
Total Valuation Charges $ .