PRO FORMA INVOICE

Exporter or Seller

Phone: Fax:
Consignee

FOR CUSTOMS CLEARANCE NOTIFY:

TAHOCO LOGISTICS, INC.
Fed ID/IRS#: Phone: 400 Riverwalk Parkway, Suite #200, Tonawanda, New York 14150
(required)
Buyer (If other than Consignee) Destination (Country): Border crossing point:
USA

Terms of Sale: FOB [ ] Plant [ ] Destination [ ] Other _______________________

U.S. Duty & Brokerage Charges For: [ ] Shipper [ ] Consignee
[ ] Other:
Fed ID / IRS# : Parties Are: [ ] Related [ ] Not Related
Local Carrier (Local) Point of Lading Duty & Brokerage Fees Included: [ ] Yes [ ] No
Discounts Included: [ ] No [ ] Yes (Details attached)
Exporting Carrier B/L, AWB, TRUCKBILL Number Invoice Date Date of Sale

Port of Entry Shipper/consignee ref# Exchange Rate Currency of Sale

Country/ Shipment total: ctns on skids Gross Weight

Province
of Origin Description of Goods H.S. Number Qty/Packaging Unit Price Invoice Total

PAPS Sticker:

If good not sold state reason for export Export Permit No. Total Invoice:

Estimated Freight Charges To be completed by Canadian Shipper ONLY when the goods described above are of U.S.

to Port of Exit $____________________ to Destination $____________________________ manufacture/growth.

Mode of Transportation Containerized DECLARATION OF SHIPPER

I _________________________________________________________________________
[ ] Road [ ] Air [ ] Rail [ ] Other [ ] Yes [ ] No
I hereby certify that the information given above and on the continuation sheet(s), declare that the articles herein specified are to the best of my knowledge and belief the growth

if any, is true and complete in every respect. produce or manufacture of the United States; that they were exported from the United States

Give Firm Name from the Port of ________________________on or about _____________________________

and Address if that they are returned without having been advanced in value or improved in condition by

different from any process of manufacture or other means.

Exporter Box above

Date: Status Signature ___________________________________________________________________

[ ] [ ]
Signature ___________________________________________ Owner Agent Status _____________________________________________________________________

20706-2012