Date:_________________
BILL OF LADING - SHORT FORM - NOT NEGOTIABLE
***THIS LOAD CONTAINS CARGO SUBJECT TO THE SANITARY TRANSPORTATION OF HUMAN AND ANIMAL FOOD (STF) RULE***
SHIP FROM
Name:
Anthem Coffee Imports
Address:
13621 Wyandotte Street
City/State/Zip:
Kansas City, MO 64145
Contact:
JV Sanoubane
Phone:
816-666-0225
Email:
[email protected]
CARRIER INFORMATION
BOL/Ref #:
Carrier Name:
Account:
Contact:
Phone:
Email:
SHIP TO
Name:
Address:
City/State/Zip:
Contact:
Phone:
Email:
AFFIX PRO LABEL HERE
THIRD PARTY FREIGHT CHARGES BILL TO
Name:
Anthem Coffee Imports
Address:
13621 Wyandotte Street
City/State/Zip:
Kansas City, MO 64145
Contact:
Earlene Hanson
Phone:
(913) 856 - 3480
Email:
[email protected]
Freight Charge Terms:
Freight charges are prepaid by
Anthem Coffee Imports unless indicated otherwise

For Assistance or authorization for additional accessorial
Please Call, JV Sanoubane at Anthem Coffee
816-666-0225
HANDLING
Handling:
Please do not double stack or load with odorous substances
Handling:
Trailer Must be Free From Dirt/Oil/Odor --- Warehouse May reject the trailer
Pickup # :
Pickup:
Delivery:
REFERENCE NUMBER INFORMATION
DescriptionQuantityPalletsTotal Shipment Weight
CARRIER SPECIAL INSTRUCTIONS
**53FT DRY VAN ONLY REQUIRED **
Consignee will unload with forklift and pallet jack from ground level
Trailer Must be Free From Dirt/Oil/Odor. PLEASE USE LOAD STRAPS TO MINIMIZE SHIFTING
Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or declared value of property as follows:
The agreed or declared value of the property is specifically stated by the shipper to be not exceeding ____________________________________________per______________
NOTE:Liability limitation for loss or damage in this shipment may be applicable. See 49 U.S.C. B14706(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 available to the shipper, on request, and to all applicable state and federal regulations.
Shipper Signature
Date
This is to certify that the above named materials are properly classified, packaged, marked, and labeled are in proper condition for transportation according to the applicable regulations of the DOT.
The carrier shall not make delivery of this shipment without payment of charges and all other lawful fees.
TRAILER LOADED:
By Shipper
By Driver
FREIGHT COUNTED
By Shipper
By Driver
Carrier Signature
Date
Carrier acknowledges receipt of packages and required placards. Carrier certifies emergency response information was made available and/or carrier has the DOT emergency guidebook or equivalent documentation in the vehicle. Property described above is received in good order except as noted.