Individual project

SELLER I EXPORTER: Name And Address I Reference No. U.S. CUstoms C learance By I FCI Cuswmer No. UPS Supply Chain Solutions SM

" SOLD TO Name and Address I Reference No. SHIP TO Name An d Addr ess {if d ifferent than sold to) I FCI Cuswmer No. U.S. IRS No .. EIN or Socia' Secu·ily No.

COUNTRY OF ORIGN U.S. Manu•act:ieel GOOds TEIU1S OF SALE

Cci·1ada a (comp;c:e dec&araL·o·1 bCJOw} CJ F.OB. Plant t:l 0 1he·

Olhe· CJ DISCOUNTS (E.x.p an} 1f ·v-..r.o.Js'. Include As Pait Of o oclarabem o r GoOds

FREtGH r To Border S Boree· To OCSL1nalion $ BILL C USTOMS CHARGES TO:

Ex:;,o·ter t:l

CJ CJ CJ 0 1he·

Prc:pa d & l 'ld.JtlOt! Prcpcrd & Chargoo Co' lecl

CAKRIER CURRENCY OF SALE:

0 1he· CON Fi.JndS t:l NAFTA Cie'.li'11Cd. B' ankc:t Cort. O n fde t:l PARTIES TO THIS TRANSACTION ARE:

FTA Nol C laimed CJ RC1C'.lt00 t:l NAFTA C lai'llCd. Cc·ltlC&I~ AUachOO CJ

Pro Forma Pre pareCI Sy PRICES INCLUD E. Dul)• t:l Brokerage t:l 0 1he· \Ex:Jtair'I )

Oa1C P llOOO NO. MARKS AND NUMBERS SHIPPING W EIGHT

Pcs. Detailed Descrfpllon of Goods H.S. No. Unit Qt)'. Unit Price

Pkgs.

TOTAL PCS. / PKGS. INVOICE TOTAL

E

c {To be complet&d onty when lhe good:S described abOve am of U.S. origin and their value exceeds S 100,000) I

declare that the articles herein specified are to U'le beSt ol my knOWledge and belief the -g-rowth--. -prod~-UCl-0t_ma_n_ul~a-cwre--o~r-,,,..-u~n;-ted~S~ta-l_e_s •&~-ll1-&y-were exported from the lkWted States from the Pott of

----------------on or abOut 20 ___ ttiat they ara returned w ithOut having been advar-.ced in value or im~d in condilion by any process of manufacture °' other means:.

AFF IX BAH

COOE LABEL HERE

F.0.B. OCSti '1<1t on

Solt! To

U.S. Fund$

U.S. FullC!$

F101g 'll

Amourt

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T Dale ________ ~

Sgned 0

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Kgs.

1. Seller/Exporter:
2. Buyer/Importer:
3. Other Terms of Sale:
4. Carrier:
5. Preparer:
6. HTS Code (10 digits):
7. Units/Qty:
8. Unit price:
9. Description of Goods:
10. Freight/shipping:
11. Product cost:
12. Freight charge:
13. Insurance premium:
14. Insurance:
15. Total invoice price:
16. Preparer's signature:
17. Date:
18. Check Box 1: Off
19. Check Box2: Off
20. Check Box3: Off
21. Check Box4: Off
22. Check Box5: Off