International Waybill #
Date of Exportation : / /
Shipper/ Exporter
Name:
Company:
Address:

Telephone: ( ) -
Consignee:
Name:
Company:
Address:

Telephone: ( ) -
Country of Export:
Country of Manufacture:
Country of Destination:

Importer - other than Consignee:

 


 
# of pkgs. Type of pkg. Description of Goods Qty. Unit of Measure Weight (lbs.) Unit Value Total Value
Total PKGS.         Total Weight   Total Value
       
lbs.		  

$ USD

For U.S. Export Only: These commodities, technology, or software were exported from the United States in accordance with the export administration regulations. Diversion contrary to United States Law is prohibited.

I declare all the information contained in this invoice to be true and correct.
 
Signature of Shipper/ Exporter: Date: / /
(pen and ink signature)
 
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