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Tax ID/VAT No.: Waybill Number: Shipment ID:
Contact Name: Date:
Company Name:
Address:
Invoice Number (Reference 1):
City State/Province: Purchase Order Number (Reference 2):
Postal Code Country/Territory: Terms of Sale (Incoterm):
Phone: Reason for Export:
Ship To
Sold To
Tax ID/VAT No.: Tax ID/VAT Number:
Contact Name: Contact Name:
Company Name: Company Name:
Address: Address:
City State/Province: City State/Province:
Postal Code Country/Territory: Postal Code Country/Territory:
Phone: Phone:
Units U/M Description of Goods/Part Number Harmonized Code C/O Unit Value Total Value Currency
Additional Comments: Invoice Line total:
Discount/Rebate:
Invoice Sub-Total:
Freight:
Declaration Statement: Insurance:
Other:
Currency
Total Invoice amount:
Shipper's Signature / Title Date Total Number of Packages:
Total Weight:
These commodities, technology, or software were exported from the United States in accordance with the Export Administration
Regulation.Diversion contrary to U.S. law is prohibited.
Invoice
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