FOR CUSTOMS CLEARANCE BY / POUR …

1 FOR CUSTOMS CLEARANCE BY / pour D DOUANEMENT PAR. INVOICE. STAPLE LINE RELEASE LABEL HERE. FACTURE. EXPORTER, SELLER, CONSIGNOR TELEPHONE SHIPPED FROM (IF DIFFERENT THAN EXPORTER). EXPORTATEUR, VENDEUR, EXP DITEUR T L PHONE EXP DIE' (SI DIFF RENT DE L'EXPORTATEUR). IRS NUMBER REFERENCE. OR S/S NUMBER R F RENCE. BUYER (IF SOLD) TELEPHONE SHIPPED TO, CONSIGNEE (IF NOT SOLD OR IF DIFFERENT THAN BUYER). ACHETEUR (SI VENDU) T L PHONE EXP DI AU DESTINATAIRE (SI NON VENDU OU SI AUTRE QUE L'ACHETEUR). IRS NUMBER REFERENCE IRS NUMBER REFERENCE. OR S/S NUMBER R F RENCE OR S/S NUMBER R F RENCE. PARTIES TO THIS TRANSACTION ARE COUNTRY OF FINAL DEST. (IF OTHER THAN ) INVOICE NUMBER. LES TRANSACTIONNAIRES SONT PAYS DE DESTINATION FINALE (SI AUTRE QUE LES .-U.) NUM RO DE FACTURE. RELATED NOT RELATED INVOICE DATE. ASSOCI S NON ASSOCI S DATE DE LA FACTURE IMPORTING CARRIER/TRANSPORTEUR L'IMPORTATION.

2 DUTY AND/OR BROKERAGE FOR / DROITS DE DOUANE AM RICAINE ET/OU FRAIS DE COURTAGE pour DATE OF SALE. DATE DE LA VENTE. EXPORTER EXPORTER. (INCLUDED) (NOT INCLUDED) BUYER CONSIGNEE DISCOUNTS. (COMPRIS) (NON COMPRIS) ACHETEUR DESTINATAIRE ESCOMPTES. OR FOR THE. ACCOUNT OF. OU pour LE CURRENCY OF VALUE CANADIAN OTHER. COMPTE DE VALEUR EN DEVISES US. CANADIENNES AUTRE. MARKS AND NUMBERS NUMBER AND KIND OF PACKAGES SHIPPING WEIGHT FREIGHT AMOUNT INCLUDED FREIGHT AMOUNT TO BORDER. MARQUES ET NUMEROS NOMBRE ET CAT GORIE DE COLIS POIDS DE L'EXP DITION MONTANT DU FRET COMPRIS MONTANT DU FRET LA FRONTI RE. COUNTRY OF ORIGIN DESCRIPTION OF GOODS QUANTITY UNIT PRICE TOTAL PRICE. & PROVINCE, IF CANADA DESCRIPTION DES MARCHANDISES QUANTIT PRIX UNITAIRE PRIX TOTAL. PAYS D'ORIGINE ET. PROVINCE, SI CANADA. Cargo Insurance is available through FedEx Trade Networks.

3 Please contact Customer Service at for a competitive quote. INVOICE TOTAL. L'assurance cargo est offerte par l'entremise de FedEx Trade Networks. Veuillez contacter le service la client le au pour une TOTAL DE LA FACTURE. estimation comp titive. DECLARATION BY FOREIGN SHIPPER (COMPLETE IF GOODS ARE OF ORIGIN AND VALUE EXCEEDS $ ). I, , DECLARE THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE ARTICLES HEREIN SPECIFIED. WERE EXPORTED FROM THE UNITED STATES, FROM THE PORT OF ON OR ABOUT AND THAT THEY ARE. RETURNED WITHOUT HAVING BEEN ADVANCED IN VALUE OR IMPROVED IN CONDITION BY ANY PROCESS OF MANUFACTURE OR OTHER MEANS. SIGNATURE CAPACITY. To the best of the knowledge and belief of the preparer this invoice is true and PREPARER (IF OTHER THAN EXPORTER) NAME OF RESPONSIBLE EMPLOYEE OF EXPORTER. complete and discloses the true prices, values, quantities, rebates, drawbacks, fees, PR PARATEUR (SI AUTRE QUE L'EXPORTATEUR) NOM DE L'EMPLOY RESPONSABLE CHEZ L'EXPORTATEUR.

4 Commissions, royalties and any goods or services provided to the seller either free or at a reduced cost. FORM 12 3/05 WV For a list of FedEx Trade Networks office locations call