DEPARTMENT OF THE TREASURY
UNITED STATES CUSTOMS SERVICE SPECIAL CUSTOMS INVOICE Form Approved
19U.S.C.1481.1482.1484. (Use separate invoice for purchased and non-purchased goods.) O.M.B.No. 48-RO342
1. SELLER 2. DOCUMENT NR. * 3. INCOICE NR. AND DATE *
4. REFERENCES *
5.CONSIGNER 6. BUYER (if other than consignee)
7. ORIGIN OF GOODS
8. NOTIFY PARTY * 9. TERMS OF SALE, PAYMENT, AND DISCOUNT
10. ADDITIONAL TRANSPORTATION INFORMATION *
11. CURRENCY USED USD 12. EXCH RATE ( If 13. DATE
fixed or agreed) ORDER
ACCEPTED