DECLARATION BY FOREIGN SHIPPER (COMPLETE IF GOODS DESCRIBED BELOW ARE OF U S ORIGIN AND VALUE EXCEEDS $1000 00) I, , DECLARE
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1. NAME OF
SHIPPER,
EXPORTER,
SELLER
2. ADDRESS
ADDRESS
3. TELEPHONE
4. CONSIGNEE9. BUYER
5. ADDRESS
ADDRESS10. ADDRESS
ADDRESS
6. IRS#11. IRS#
12. BILL U.S. DUTY, MPF, AND/OR BROKERAGE TO:
CONSIGNEE BUYER SHIPPER13. ACCOUNT NUMBER14. PORT OF ENTRY15.
U.S. DUTY
AND BROKERAGE
INCLUDED IN INVOICE VALUE:
YES NO16. PLACE OF LADING (CITY/PROVINCE)17. TERMS OF SALE, PAYMENT, AND DISCOUNT
F.O.B.
PLANT DESTINATION, OR
18. LOCAL CARRIER19. BILL OF LADING #20. DATE OF SALE21. DERINGER TO PROVIDE CARGO INSURANCE?
YES NO
22. EXPORTING CARRIER23. IS FREIGHT INCLUDED IN INVOICE VALUE?
NOYES AMOUNT
CURRENCY
24. CURRENCY25. PARTIES TO THIS TRANSACTION ARE:
RELATED NOT RELATED
DECLARATION BY FOREIGN SHIPPER (COMPLETE IF GOODS DESCRIBED BELOW ARE OF U.S. ORIGIN AND VALUE EXCEEDS $1000.00)
I, , DECLARETO THE BEST OF MY KNOWLEDGE AND BELIEF THE ARTICLES HEREIN SPECIFIED ARE PRODUCTS OF THE UNITED STATES; THAT
THEY WERE EXPORTED FROM THE UNITED STATES, FROM THE PORT OFON OR ABOUT , THAT THEY
ARE RETURNED WITHOUT HAVING BEEN ADVANCED IN VALUE OR IMPROVED IN CONDITION BY ANY PROCESS OF MANUFACTURE OR OTHER MEANS.
SIGNATURE
CAP ACITY26. SHIPPING WEIGHT
KGS LBSCOUNTRY OF
MANUFACTURE
OR GROWTH
MARKS AND NUMBERS NUMBER AND KIND OF PACKAGES
DESCRIPTION OF GOODSHTS NUMBERQUANTITYUNIT PRICETOTAL PRICE If the production of these goods involved furnishings, goods, or service s to the seller (e.g., assists such as dies, molds, too ls, engineering work), and the value is not included in the invoice pri ce, give explanation.If no assists, state so.
This invoice must specifically state that the applicable duty or fees fo r ADD/CVD, MPF, HMF, beef, pork, and honey fees are included in the invoice price. To the best of my knowledge as the preparer, this invoice is true and complete and discloses trueprices, values, quantities, rebates, drawbacks, fees, commissions, royalities, and any goods or services
provided to the seller either free or at a reduced cost.