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I declare all information contained on this invoice to be true and correct.
PROFORMA INVOICE
Not being in posession of a commercial seller's or shipper's invoice, I request that you accept the statement of value or the price paid
in the form of an invoice submitted below. (19CFR 141.85)
DATETITLESIGNATURE
SHIPPER
Description
Product No., Harmonized No.
Country of Origin, Serial No.
Unit Price
Page ____ of ____
Total PriceItem No
Invoice Date:
UOM
Ship Date:
Quantity
File Number:
CONSIGNEE BILL TO
--- SHIPMENT INFORMATION ---
Letter of Credit No: Mode of Transportation:Customer PO No:
Currency: Transportation Terms:PO Date:
Ref No: Number of Packages:Payment Terms:
AWB/BL No: Gross Weight(Kg):Incoterms Desc:
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