Importer Security Filing

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Name:
Email:
Phone#:
Estimated Sailing/Export Date:(MMDDYY)
Transship: Transship Date:(MMDDYY)
Reference#:
Doc Received: (MMDDYY)(For Internal Use Only)
Doc Received by (For Internal Use Only)
Vessel:
Voyage:
SCAC Code: Template?
Bill of Lading & Type:
Regular Bill House Bill
Name of Importer:
Importer of Record:
(Leave Importer of Record field blank if same as Name of Importer)
Name of Consignee:

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[ Seller Info ]
Name:

Address:
City:
State:
Province:
Postal/Zip Code:
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[ Manufacturer/Supplier Info ]
Name:

Address:
City:
State:
Province:
Postal/Zip Code:
 

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[ Buyer Info ]
Name:

Address:
City:
State:
Province:
Postal/Zip Code:
* More than 1 Buyer Info
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[ Ship to Party Info ]
Name:

Address:
City:
State:
Province:
Postal/Zip Code:
* More than 1 Ship to Party Info


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[ Container Stuffing Location ]
Name:

Address:
City:
State:
Province:
Postal/Zip Code:
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[ Consolidator ]
Name:

Address:
City:
State:
Province:
Postal/Zip Code:
* More than 1 Consolidator

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