Exporter: Date: PO #:
Order Number: Terms:
Ultimate Consignee: Commercial Invoice Number: Customer Account:
Exporter Phone Number: Pro Forma Invoice Number:
Intermediate Consignee: Exporting Carrier: Loading Pier/Terminal:
Point of Origin (FTZ No.): Ultimate Destination:
Units: Pieces: Description of Commodities / Schedule B Number / Marks Value:

We certify that this invoice is true and correct and that these goods are licensed for Ultimate Destination.

Diversion contrary to US law is prohibited.

Ex-Factory Costs:
Inland Freight Costs:
Ocean/Air Costs:
Handling Fees:
Insurance Costs:
Consular Fees:
Total US Dollars:



Authorised signature: _____________________________