Bill of Lading and Household Goods Contract
No. ________
________
________
________
USDOT ________ · MC ________
Shipper
________
________
________
- Move date
- ________
- Delivery date
- ________
- Estimate type
- Non-binding estimate
Origin
________
Destination
________
Inventory and condition at pickup
| Qty | Description | Condition at pickup |
|---|---|---|
Valuation
Released value (60¢ per lb per article)
Declared value: ________ · Deductible: ________
Charges
| Transportation | ________ |
| Packing and materials | ________ |
| Other | ________ |
| Total | ________ |
Payment terms
________
Special instructions
Terms: The shipper acknowledges receipt of the carrier's written estimate and the valuation options, and agrees that the goods listed above were received by the carrier in the condition noted. The carrier's liability is limited to the valuation selected. Any claim for loss or damage must be made in writing to the carrier within nine months of delivery. Charges are due as stated under payment terms; goods may be held pending payment of undisputed charges as permitted by law.
Shipper signature at pickup / date
Carrier signature at pickup / date
Shipper signature at delivery / date
Carrier signature at delivery / date