Customs in Voice

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4.

PAGE OF PAGES
PERMAN STOLER CHB, INC. CUSTOMS INVOICE 1
1. SHIPPER - NAME AND ADDRESS REF. NO. 2. U.S. CUSTOMS HANDLED BY: 3. OTHER REF. NOS.

PERMAN STOLER CHB, INC


P.O. BOX 190066
ANCHORAGE, AK 99519
PHONE: 907-243-3313
PHONE CONTACT FAX: 907-243-4519

5. CONSIGNEE / SHIP TO PARTY NAME AND ADDRESS 6. IMPORTER OF RECORD NAME AND ADDRESS

IRS/TAX ID# OR IRS/TAX ID# OR


SOCIAL SECURITY # SOCIAL SECURITY #
* MANDATORY FOR U.S. CLEARANCE * MANDATORY FOR U.S. CLEARANCE

7. BILL CUSTOM CHARGES TO


SHIPPER CONSIGNEE OR

10. U.S. DUTY AND BROKERAGE 8. ORIGIN (COUNTRY/PROVINCE) 9. DESTINATION (COUNTRY/STATE)


INCLUDED IN INVOICE VALUE YES NO
14. TERMS OF SALE, PAYMENT AND DISCOUNT
11. PARTIES TO THIS TRANSACTION ARE NOT
RELATED RELATED

12. DATE OF EXPORT


IF THE GOODS ARE OF U.S. ORIGIN,
THEY MUST BE PRODUCED OR
MANUFACTURED IN THE U.S. AND
13. EXPORTING CARRIER NOT MERELY SHIPPED/PURCHASED 15. CURRENCY USED 16. IS FREIGHT YES: NO:
FROM THE U.S. INCLUDED IN INVOICE
VALUE? IF YES YOU MUST COMPLETE BOX 26
17. 18. 19. 20. 21. 22. 23.
COUNTRY OF HS TARIFF NO OF DESCRIPTION OF GOODS UNIT QUANTITY UNIT PRICE TOTAL
MANU- UNITS GIVE SUFFICIENT DETAIL TO PERMIT CLASSIFICATION (TONS, CWT, LBS,
FACTURE OR ACCORDING TO TARIFF SCHEDULE OF THE U.S. F.B.M., ETC)
GROWTH

SHIPPING WEIGHT. GROSS: NET: lbs kgs


24. US CUSTOMS PORT OF ENTRY: 25. TOTAL
<< TOTAL PACKAGES INVOICE VALUE >>
26. ACTUAL FREIGHT CHARGES 28. IF GOODS NOT SOLD STATE REASON FOR
TO PORT OF EXIT $ TO DESTINATION $ REPORT (LOAN, REPAIR, PROCESSING, ETC.)

29. MODE OF TRANSPORTATION FROM POINT OF EXIT 30. CONTAINERIZED


ROAD RAIL AIR OCEAN YES: NO:
31. EXPORTING CARRIER AIR WAYBILL AND OR BILL OF LADING NUMBER 32. I HEREBY CERTIFY THAT THE INFORMATION GIVEN ABOVE AND ON THE
CONTINUATION SHEET(S), IF ANY, IS TRUE AND COMPLETE IN EVERY RESPECT.
STATUS:
DATE:

YOUR NAME OR SIGNATURE:


SHIPPER: AGENT:
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