Entry Summary: U.S. Customs and Border Protection

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DEPARTMENT OF HOMELAND SECURITY OMB APPROVAL NO.

1651-0022
EXPIRATION DATE 01/31/2021
U.S. Customs and Border Protection ESTIMATED BURDEN 10 MIN

1. Filer Code/Entry No. 2. Entry Type 3. Summary Date


ENTRY SUMMARY
4. Surety No. 5. Bond Type 6. Port Code 7. Entry Date

8. Importing Carrier 9. Mode of Transport 10. Country of Origin 11. Import Date

12. B/L or AWB No. 13. Manufacturer ID 14. Exporting Country 15. Export Date

16. I.T. No. 17. I.T. Date 18. Missing Docs 19. Foreign Port of Lading 20. U.S. Port of Unlading

21. Location of Goods/G.O. No. 22. Consignee No. 23. Importer No. 24. Reference No.

25. Ultimate Consignee Name and Address 26. Importer of Record Name and Address

City State Zip City State Zip

28. Description of Merchandise 32. 33. 34.


27. A. HTSUS Rate Duty and I.R. Tax
29. 30. 31. A. Entered Value B. ADA/CVD Rate
Line B. CHGS Dollars Cents
A. HTSUS No. A. Grossweight Net Quantity in C. IRC Rate
No. B. ADA/CVD No. B. Manifest Qty. HTSUS Units C. Relationship D. Visa No.

Other Fee Summary for Block 39 35. Total Entered Value CBP USE ONLY TOTALS
A. LIQ CODE B. Ascertained Duty 37. Duty
$
Total Other Fees REASON CODE C. Ascertained Tax 38. Tax
$
36. DECLARATION OF IMPORTER OF RECORD (OWNER D. Ascertained Other 39. Other
OR PURCHASER) OR AUTHORIZED AGENT
I declare that I am the Importer of record and that the actual owner, E. Ascertained Total 40. Total
purchaser, or consignee for CBP purposes is as shown above, OR owner
or purchaser or agent thereof. I further declare that the merchandise was obtained pursuant to a purchase or agreement to purchase and that the
prices set forth in the invoices are true, OR was not obtained pursuant to a purchase or agreement to purchase and the statements in the invoices as
to value or price are true to the best of my knowledge and belief. I also declare that the statements in the documents herein filed fully disclose to the best
of my knowledge and belief the true prices, values, quantities, rebates, drawbacks, fees, commissions, and royalties and are true and correct, and that all
goods or services provided to the seller of the merchandise either free or at reduced cost are fully disclosed.
I will immediately furnish to the appropriate CBP officer any information showing a different statement of facts.
41. DECLARANT NAME TITLE SIGNATURE DATE

42. Broker/Filer Information (Name, address, phone number) 43. Broker/Importer File No.

Paperwork Reduction Act Notice

CBP Form 7501 (2/18) Page 1 of 5


OMB APPROVAL NO. 1651-0022
EXPIRATION DATE 01/31/2021
DEPARTMENT OF HOMELAND SECURITY ENTRY SUMMARY CONTINUATION SHEET ESTIMATED BURDEN 10 MIN

U.S. Customs and Border Protection 1. Filer Code/Entry No.

27. 28. Description of Merchandise 32. 33. 34.


A. HTSUS Rate Duty and I.R. Tax
29. 30. 31.
A. Entered Value B. ADA/CVD Rate
Line A. HTSUS No. A. Grossweight Net Quantity in B. CHGS C. IRC Rate Dollars Cents
No. B. ADA/CVD No. B. Manifest Qty. HTSUS Units C. Relationship D. Visa No.

CBP Form 7501 (2/18) Page 2 of 5


OMB APPROVAL NO. 1651-0022
EXPIRATION DATE 01/31/2021
DEPARTMENT OF HOMELAND SECURITY ENTRY SUMMARY CONTINUATION SHEET ESTIMATED BURDEN 10 MIN

U.S. Customs and Border Protection 1. Filer Code/Entry No.

27. 28. Description of Merchandise 32. 33. 34.


A. HTSUS Rate Duty and I.R. Tax
29. 30. 31.
A. Entered Value B. ADA/CVD Rate
Line A. HTSUS No. A. Grossweight Net Quantity in B. CHGS C. IRC Rate Dollars Cents
No. B. ADA/CVD No. B. Manifest Qty. HTSUS Units C. Relationship D. Visa No.

CBP Form 7501 (2/18) Page 3 of 5


OMB APPROVAL NO. 1651-0022
EXPIRATION DATE 01/31/2021
DEPARTMENT OF HOMELAND SECURITY ENTRY SUMMARY CONTINUATION SHEET ESTIMATED BURDEN 10 MIN

U.S. Customs and Border Protection 1. Filer Code/Entry No.

27. 28. Description of Merchandise 32. 33. 34.


A. HTSUS Rate Duty and I.R. Tax
29. 30. 31.
A. Entered Value B. ADA/CVD Rate
Line A. HTSUS No. A. Grossweight Net Quantity in B. CHGS C. IRC Rate Dollars Cents
No. B. ADA/CVD No. B. Manifest Qty. HTSUS Units C. Relationship D. Visa No.

CBP Form 7501 (2/18) Page 4 of 5


OMB APPROVAL NO. 1651-0022
EXPIRATION DATE 01/31/2021
DEPARTMENT OF HOMELAND SECURITY ENTRY SUMMARY CONTINUATION SHEET ESTIMATED BURDEN 10 MIN

U.S. Customs and Border Protection 1. Filer Code/Entry No.

27. 28. Description of Merchandise 32. 33. 34.


A. HTSUS Rate Duty and I.R. Tax
29. 30. 31.
A. Entered Value B. ADA/CVD Rate
Line A. HTSUS No. A. Grossweight Net Quantity in B. CHGS C. IRC Rate Dollars Cents
No. B. ADA/CVD No. B. Manifest Qty. HTSUS Units C. Relationship D. Visa No.

CBP Form 7501 (2/18) Page 5 of 5

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