United States Customs Service
2. Date of Entry and Importation
3. Manufacturer/Seller/Shipper
5a. Invoice Description of Merchandise
7. Country of Origin/Exportation
8. Customs Broker and Reference or File No.
11b. Date Information
Furnished
Production of Documents and/or Information Required by Law: If you have provided the information requested on this form to U.S. Customs at other ports, please indicate the port of entry to which it was supplied, and furnish a copy of your reply to this office, if possible.
Any data typed after screen scrolls will not print.
Form Assistant
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