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Date Shipper Name Contact Person Street Address Invoice # Consignee Name Contact Person Street Address
City Country Telephone Number Tax ID Number (EIN) Other Information. (i.e. ITN #)
Postal Code Email Address Fax Number Exporting Carrier: DHL Total # of Pieces HTS, Schedule B
City Country Telephone Number Tax ID Number (i.e. EIN,VAT) Total Gross Weight in Kilos Country of Manufacture Quantity, Unit of Measure
Postal Code Email Address Fax Number Incoterms AWB # Unit Price USD $ Total Price USD $
Subtotal (USD $) I/we hereby certify that the information on this invoice is true and correct and that the contents of this shipment are as stated above. Freight Cost Insurance Cost Total Invoice Value (USD $)
70
Date
These commodities, technology, or software were exported from the United States of America for ultimate destination ____________________ in accordance with export administration regulations. Diversion contrary to U.S. law is prohibited.
Version 01/2007