Shipper Information
Name:
Address:
City:
Country/Territory:
State/Province:	Postal Code:

Consignee (Recipient) Information
Company Name:
Contact Name:
Address:
City:
Country/Territory:
State/Province:	Postal Code:
Telephone:	Ext:

Importer (if other than Consignee):
Importer:

Invoice Information
Date:
Reference Number:
Country of Origin:
Country of Ultimate Destination:

Shipment Information
Item #1
Marks & Numbers:
Number of Packages:
Complete Description of Goods:
Weight:
Quantity:
Unit Value:
Total Value:
Item #2
Marks & Numbers:
Number of Packages:
Complete Description of Goods:
Weight:
Quantity:
Unit Value:
Total Value:
Item #3
Marks & Numbers:
Number of Packages:
Complete Description of Goods:
Weight:
Quantity:
Unit Value:
Total Value:
Item #4
Marks & Numbers:
Number of Packages:
Complete Description of Goods:
Weight:
Quantity:
Unit Value:
Total Value:
Item #5
Marks & Numbers:
Number of Packages:
Complete Description of Goods:
Weight:
Quantity:
Unit Value:
Total Value:

If additional item space is necessary to complete this form, please enter the number below:
Number of additional items: