Customs Invoice Example - Mendelssohn Commerce
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1FOR CUSTOMS CLEARANCE BY:
LEAVE BLANK
U.S. INVOICE
BLANK
SHIPMENT REFERENCE: __________
EXPORTER (SHIPPER)
CONSIGNEE (SHIPPED TO)
Broker Account Holder:
LEAVE BLANK
ABC COMPANY
Ship From:
Broker Account Number:
LEAVE BLANK
111 ANY STREET
TORONTO, ON
ABC COMPANY
Ship To:
M1M 1M1
C/O SHOW NAME, BOOTH #
ADVANCED WHSE OR SHOW FACILITY
JOE SMITH
111 SOMEWHERE PLACE
(416)555-5555
NEW YORK, NY
10001 USA
11-1111111
IRS #:
SHIPMENT DATE:
CURRENCY OF DECLARED VALUE:
NUMBER AND KINDS OF PACKAGES:
GROSS WEIGHT:
U.S.
03/14/2014
LBS
CANADIAN
4 BOXES
400
KG
(MM/DD/YYYY)
OTHER: _________________
COUNTRY OF
UNIT
DESCRIPTION OF GOODS
U.S. H.S. NUMBER
QTY
TOTAL VALUE
ORIGIN
VALUE
1
$5,000.00
$5,000.00
DISPLAY BOOTH
CANADA
$500.00
LITERATURE
CANADA
5,000
$0.10
COMPUTERS (FCC & RADIATION FORMS ENCL.)
JAPAN
LEAVE BLANK
3
$1,500.00
$4,500.00
$1,500.00
MONITORS (FCC & RADIATION FORMS ENCL.)
CHINA
3
$500.00
STOOLS
CANADA
2
$100.00
$200.00
INVOICE TOTAL
$ 11,700.00
SHIPMENT INSTRUCTIONS:
(TO BE COMPLETED BY MENDELSSOHN COMMERCE)
PAPS / SCN:
TYPE OF ENTRY:
ALL CHARGES TO ACCOUNT #:
EMERGENCY DAYTIME CONTACT:
EMERGENCY AFTER-HOURS CONTACT:
NOTES FOR BROKER:
U.S. PORT OF ARRIVAL :
DATE (MM/DD/YYYY):
TIME (EASTERN):
1)
I hereby certify that the information provided on this invoice, and all other forms relating to this invoice (i.e. FCC 740, FDA 2877 if applicable) are true and
correct.
2)
I hereby indemnify Mendelssohn Commerce, and their appointed agents and/or the exhibition organizers against any claim by Customs authorities for
duty, taxes, or penalties due to the wrongful removal of these goods from Customs control.
AUTHORIZED SIGNATURE:
DATE:
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