Contact Email*

Master B.L.#:

SCAC Code:

AMS House B.L.#:

SCAC Code:

Vessel Name:

ETD:

Container#:

Seller’s Info

Name and complete address of the final seller of the goods or the owner if no seller

Is the Seller the same as the manufacturer?

We will use this to duplicate the information on this form.

Yes, the seller is the same is the manufacturer.

No, the information is different, we will update below accordingly.

Seller’s Company Name:*

Seller's Address

Seller Street Address*

Street Address

Seller Address Line 2

Address Line 2

Seller's City*

City

Seller State / Province / Region

State / Province / Region

Seller's Zip / Postal Code

Zip / Postal Code

Seller's Country

Country

Buyer’s Info

Name and a complete address for the last known entity to whom the goods are sold or the owner if no purchase

Is the buyer the same as the importer?

We will use this to duplicate the information on this form.

Yes, the buyer is the same is the importer.

No, the information is different, we will update below accordingly.

Is the buyer the same as the consignee?

We will use this to duplicate the information on this form.

Yes, the buyer is the same is the consignee.

No, the information is different, we will update below accordingly.

Buyer's Company Name:

Buyer's Address

Buyer's Street Address*

Street Address

Buyer's Address Line 2

Address Line 2

Buyer's City

City

Buyer's State / Province / Region

State / Province / Region

Buyer's Zip / Postal Code

Zip / Postal Code

Buyer's Country

Country

Importer Information

IRS# or EIN# or Social Security#, Name and complete address

Importer Company Name:

Importer Address

Importer Street Address*

Street Address

Importer Address Line 2

Address Line 2

Importer's City*

City

Importer State / Province / Region

State / Province / Region

Importer Zip / Postal Code*

Zip / Postal Code

Importer's Country

Country

Consignee Information

IRS# or EIN or Social Security #, Name and complete address, must be a U.S. company

Consignee Company Name:

Consignee Address

Consignee Street Address*

Street Address

Consignee Address 2

Address 2

Consignee City*

City

Consignee State

State

Consignee Zip Code

Zip Code

Manufacturer / Supplier Information

Name and complete address of the entity that last manufactured/assembled/produced or grew the product or the party supplying the goods

Manufacturer / Supplier Company Name:

Manufacturer / Supplier Address

Manufacturer / Supplier Street Address*

Street Address

Manufacturer / Supplier Address Line 2

Address Line 2

Manufacture City

City

Manufacture State / Province / Region

State / Province / Region

Manufacture Zip / Postal Code

Zip / Postal Code

Manufacture Country

Country

Ship To Party

Name & complete address of 1st “deliver to” party scheduled to receive the goods after Customs Clearance

Ship To Party Company Name:

Ship To Party Address

Ship to Party Address

Street Address

Ship to Party Address 2

Address Line 2

Ship to Party City

City

Ship to Party State

State

Ship to Party Zip Code

Zip Code

Country of Origin:

Based on U.S. Customs Regulations

Commodity HTSUS# (Six digit classification#):

Pro Forma Invoice

Max. file size: 256 MB.

Please attach a Pro Forma invoice copy so the harmonized numbers can be determined

Container Stuffing Location

Name and complete address of the physical location that the freight was loaded/stuffed in the container

Container Stuffing Location Company Name:

Container Stuffing Location Address

Container Stuffing Street Address

Street Address

Container Stuffing Address 2

Address Line 2

Container Stuffing City

City

Container Stuffing State / Province / Region

State / Province / Region

Container Stuffing Zip / Postal Code

Zip / Postal Code

Container Stuffing Country

Country

Consolidater

Name and complete address of the party that stuffed the container or arranged for the stuffing i.e. Forwarder

Consolidater Company Name:

Consolidater Address

Consolidater Street Address

Street Address

Consolidater Address Line 2

Address Line 2

Consolidater City

City

Consolidater State / Province / Region

State / Province / Region

Consolidater Zip / Postal Code

Zip / Postal Code

Consolidater Country

Country

Comments

This field is for validation purposes and should be left unchanged.

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Seller’s Info

Buyer’s Info

Importer Information

Consignee Information

Manufacturer / Supplier Information

Ship To Party

Container Stuffing Location

Consolidater

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Ken Lehat & Associates, Inc.