Customs Invoice

Exporter or Seller

Tel: Fax:
Consignee You'd be surprised how far we'll go for you!

FOR CUSTOMS CLEARANCE NOTIFY:

Expeditors International of Washington, Inc.
Fed ID/IRS#:
Buyer (If other than Consignee) Destination (Country): Border crossing point:

U.S.A.

Terms of Sale: FOB [ ] Plant [ ] Destination [ ] Other ________________________________

U.S. Duty & Brokerage Charges For: [ ] Shipper [ ] Consignee

[ ] Other:
Fed ID/IRS#: Parties Are: [ ] Related [ ] Not Related

Local Carrier (Local) Point of Lading Duty & Brokerage Fees Included: [ ] Yes [ ] No

Discounts Included: [ ] No [ ] Yes; details attached

Exporting Carrier B/L, AWB, TRUCKBILL Number Invoice Date Date of Sale

Port of Entry Shipper/consignee ref# Exchange Rate Currency of Sale

Country/ Shipment total: ctns on skids Gross Weight

Province
of Origin Description of Goods H.S. Number Quantity/Packaging Unit Price Invoice Total

$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
If good not sold state reason for export Export Permit No. Total Invoice: $0.00

Estimated Freight Charges To be completed by Canadian Shipper ONLY when the goods described above are of U.S.

to Port of Exit $____________________ to Destination $____________________________ manufacture/growth.

Mode of Transportation Containerized DECLARATION OF SHIPPER

I _________________________________________________________________________
( ) Road ( ) Air ( ) Rail ( ) Other ( ) Yes ( ) No
I hereby certify that the information given above and on the continuation sheet(s), if any, is declare that the articles herein specified are to the best of my knowledge and belief the growth

true and complete in every respect. produce or manufacture of the United States; that they were exported from the United States

Give Firm Name from the Port of ________________________on or about _____________________________

and Address if that they are returned without having been advanced in value or improved in condition by

different from any process of manufacture or other means.

Exporter Box above

Date: Status Signature ___________________________________________________________________

( ) ( )
Signature ___________________________________________ Owner Agent Status _____________________________________________________________________
Border Point State Contact Telephone Fax

Alexandria Bay New York Expeditors c/o A.N. Deringer 315 482-2583 315 482-4626
Bangor Maine Expeditors c/o A.N. Deringer 207 947-3534 207 941-0238
Blaine Washington Expeditors c/o A.N. Deringer 360 332-6600 360 332-4062
Buffalo (Peace Bridge) New York Expeditors International 716 886-4822 716 886-5224
Calais Maine Expeditors c/o A.N. Deringer 207 454-3951 207 454-8439
Champlain New York Expeditors c/o A.N. Deringer 518 298-8281 518 298-7430
Derby Line Vermont Expeditors c/o A.N. Deringer 802 873-3109 802 873-9113
Detroit (Ambassador Bridge) Michigan Expeditors International 734 857-5150 734 857-5153
Eastport Idaho Expeditors c/o A.N. Deringer 208 267-5021 208 267-5448
Grand Portage (Int'l Falls) Minnesota Expeditors c/o A.N. Deringer 218 722-5853 218 722-5124
Highgate Springs Vermont Expeditors c/o A.N. Deringer 802 466-8600 802 466-8653
Houlton Maine Expeditors c/o A.N. Deringer 207 532-2907 207 532-9462
Jackman Maine Expeditors c/o A.N. Deringer 207 668-7712 207 668-4034
Massena New York Expeditors c/o A.N. Deringer 315 769-0203 315 769-0204
Niagara Falls (Queenston Lewiston Bridge) New York Expeditors International 716 278-0907 716 278-0909
Norton Vermont Expeditors c/o A.N. Deringer 802 822-5252 802 822-5204
Ogdensberg New York Expeditors c/o A.N. Deringer 315 393-1110 315 393-1357
Pembina North Dakota Expeditors c/o A.N. Deringer 701 825-6457 701 825-6212
Port Huron (Blue Water Bridge) Michigan Expeditors International 734 857-5160 734 857-5163
Portal North Dakota Expeditors c/o A.N. Deringer 701 926-4011 701 926-4031
Sault Ste Marie Michigan Expeditors c/o A.N. Deringer 906 635-5004 906 635-6125
Sweetgrass Montana Expeditors c/o A.N. Deringer 406 335-2300 406 335-2295