美國鎢制品出口海關發票

SPECIAL CUSTOMS INVOICE
(Use separate invoice for purchased and non-purchased goods.)

Form Approved.
O.M.B.No. 48-RO 342

1. SELLER

2. DOCUMENTS NR.*

3. INVOCIE NR. AND DATE*

4. REFERENCES*

5. CONSIGNEE

6. BUYER (if other than consignee)

7. ORIGIN OF GOODS

8. NOTIFY PARTY*

9. TERMS OF SALE, PAYMENT, AND DISCOUNT

10. ADDITIONAL TRANSPORTATION INFORMATION*

11. CURRENCY USED

12. EXCH RATE (if fixed or ogreed)

13. DATE ORDER ACCEPTED

IN USD

14.
MARKS AND NUMBERS ON
SHIPPING PACKAGES

15.
NUMBER OF
PACKAGES

16.
FULL DESCRIPTION
OF GOODS

17.
QUANTITY

UNIT PRICE

20.
INVOICE TOTALS

18.HOME
MARKET

19.INVOICE

21.

□

If the production of these goods involved furnishing goods or services to the seller (e.g., assists such as dies, molds,
Tools, engineering work) and the value is not included in the invoice price, check box (21) and explain below.

22. PACKING COSTS

27. DECLARATION OF SELLER/SHIPPER (OR AGENT)

23. OCEAN OR
INTERNATIONAL
FREIGHT

I declare:

(A)

□

If the are any rebates, drawbacks or
bounties allowed upon the exportation
of goods, I have checked box (A) and
itemized separately below.

(B)

□

If the goods were not sold or agreed to be sold, I have checked
box (B) and have indicated in column 19 the price I would be
willing to receive.

24. DOMESTIC
FREIGHT CHARGES

25. INSURANCE
COSTS

I further declare that there is no other invoice
differing from this one (unless otherwise described
below) and that all statements contained in this
invoice and declaration are true and correct.

(C) SIGNATURE OF SELLER/SHIPPER (OR AGENT):

26. OTHER COSTS
(Specify Below)

28. THIS SPACE FOR CONTINUING ANSWERS

THIS FORM OF INVOICE REQUIRED GENERALLY IF RATE OF DUTY BASED UPON OR REGULATED BY VALUE OF GOODS AND PURCHASE PRICE OR VALUE OF SHIPMENT EXCEEDS $500. OTHERWISE USE COMMERICAL INVOICE.

*Not necessary for U.S.Customs purposes.
Printed by CHEUNG LEE PRINTING CO., 204 Li Po Chun Chambers 185 Des Voeux Road. C., Hong Kong Tel: 5-438069. 5-441501

Customs Form 5515 (12-20-76)