COMBINATION: INVOICE - DECLARATION BY FOREIGN SHIPPER
L 10 EX 3/11
FOR CUSTOMS CLEARANCE BY
For U.S. Customs clearance send documents to:
USImports@livingstonintl.com
or by fax to 1-877-548-7277
For customs status updates 24/7:
track online at
www.livingstontracker.com
or call us at 1-866-548-7277
INVOICE
SHIPMENT REFERENCE:
SHIPMENT CONTROL #:
EXPORTER, SELLER
PRODUCER OF GOODS (IF DIFFERENT THAN EXPORTER)
SHIPPED TO, CONSIGNEE
BUYER (IF DIFFERENT THAN CONSIGNEE)
PARTIES TO THIS TRANSACTION ARE
RELATED NOT RELATED
COUNTRY OF FINAL DEST. (IF OTHER THAN U.S.A.)
INVOICE DATE
DATE OF SALE
U.S. DUTY / BROKERAGE FOR ACCOUNT OF:
EXPORTER SHIP TO, CONSIGNEE OTHER (specify)
____________________________
LIVINGSTON ACCOUNT NUMBER:
DISCOUNTS
PORT OF ENTRY:
TERMS OF SALE
U.S. CANADIAN OTHER (specify)
NUMBERS AND KIND OF PACKAGES
SHIPPING WEIGHT
FREIGHT AMOUNT INCLUDED
FREIGHT AMOUNT TO BORDER
COUNTRY OF ORIGIN
DESCRIPTION OF GOODS TEN DIGIT H.T.S. NUMBER UNIT QTY.
UNIT PRICE INVOICE TOTAL
If food is being imported, have any of the food items on this shipment been refused by any other
countries? No Yes (if yes please specify which products have been refused and the
name of the country that refused them).
INVOICE TOTAL
ABOVE PRICES INCLUDE
DUTY BROKERAGE FREIGHT
DECLARATION BY FOREIGN SHIPPER (To be completed only when the goods described above are of U.S. origin and their value exceeds $500.00)
I __________________________________ declare that the articles herein specified are to the best of my knowledge and belief, the growth, produce or manufacture of the United
States: That they were exported from the United States from the port of
______________________________
on or about ___________________________ that they are returned
without having been advanced in value or improved in condition by any process of manufacture or other means. Any shipment that contains U.S. goods returned valued over $2,500
should have a manufacturer’s affidavit attached to this invoice.
To the best of the knowledge and belief of the preparer this invoice is true and complete
and discloses the true prices, values, quantities, rebates, drawbacks, fees,
commissions, royalties and any goods or services provided to the seller either free orat
a reduced cost.
PREPARER (IF OTHER THAN EXPORTER)
NAME OF RESPONSIBLE EMPLOYEE OF EXPORTER
COMMENTS
