Name：

Company：

Street Address：

City：

State：

Zip：

Phone：

Fax：

E-mail：

Ocean Service ：

Air Service：

Common Cargo
Dangerous Cargo

PPD/CC

Commodity*
(Be specific)

Declared Value of Customs

Piece Count

Gross Weight in KG *

Dimensions in CBM *

Shipment Origin *
(Port & Country or City, State & Zip)

Shipment Destination *
(Port & Country or City, State & Zip)