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____________________ Location #: __________ City/State/Zip: CID#: Trailer number: Seal number(s): SCAC: Pro number: FOB: THIRD PARTY FREIGHT CHARGES BILL TO: Name: Address: BAR CODE SPACE City/State/Zip: Freight Charge Terms: (freight charges are prepaid SPECIAL INSTRUCTIONS: Prepaid ______ unless marked otherwise) (check box) CUSTOMER ORDER NUMBER # PKGS Collect _____ 3rd Party _____ Master Bill of Lading: with attached underlying Bills of Lading CUSTOMER ORDER INFORMATION PAL.

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