2401 NW 69th St. EXPORTER'S EIN NUMBER PARTIES RELATED Miami, Florida 33147 YES / NO (CIRCLE ONE) Phone: (305) 693-5133 ULTIMATE CONSIGNEE Fax: (305) 675-9258 FREIGHT CHARGES (INDICATED PPD OR COL) PREPAID OR COLLECT DECLARED VALUE FOR CARRIAGE INTERMEDIATE CONSIGNEE / NOTIFY PARTY $ SHIPPER REQUESTS INSURANCE: (IF NO LEAVE BLANK)
STATE OF ORIGIN COUNTRY OF ULTIMATE DESTINATION
LOADING PIER MODE OF TRANSPORT SHIPPER'S REFERENCE NUMBER
AIR / OCEAN (CIRCLE ONE) EXPORTING CARRIER PORT OF EXPORT CONSIGNEE'S REFERENCE NUMBER PORT OF UNLOADING CONTAINERIZATION YES / NO (CIRCLE ONE)
D/F H.S. NUMBER QUANTITY SHIPPING WEIGHT VALUE (USD)
LICENSE / ECCN ECI Quote Number
INLAND ROUTING INFORMATION SHIPPER'S INSTRUCTIONS IN CASE OF
CARRIER CHARGES INABILITY TO DELIVER AS CONSIGNED PREPAID COLL ABANDON YES NO OVERHEAD RETURN TO SHIPPERYES NO SHIPPING DOCUMENTS: ATTACHED CONTACT SHIPPER YES NO ADDITIONAL COMMENTS: DOCUMENTS TO BE COMPLETED BY ECI (Please note here if any expedited services are needed (STATE YES/NO TO WHICH APPLY) or if any special handling is required.) COMMERCIAL INVOICE CERTIFICATE OF ORIGIN CONSULAR INVOICES ADDITIONAL DOCUMENTS:
BANKING SERVICES: (eg. Letter of Credit, Draft, etc.) YES / NO
DULY AUTHORIZED OFFICER OR EMPLOYEE. THE EXPORTER AUTHORIZES RECEIVED BY:
THE FORWARDER NAMED ABOVE TO ACT AS FORWARDING AGENT FOR (BY TRUCKER) EXPORT CONTROL AND CUSTOMS PURPOSES. (SHIPPER MUST SIGN HERE) ***All Cargo Tendered for Transportation is Subject to Inspection***