Importer Security Filing

Contact Email*

Master B.L.#:

SCAC Code:

AMS House B.L.#:

SCAC Code 2:

Vessel Name:

ETD:

Container#:

Seller’s Info

Name and complete address of the final seller of the goods or the owner if no seller

Seller’s Company Name:

Seller's Address

Seller Street Address*

Street Address

Seller Address Line 2

Address Line 2

Seller's City*

City

Seller State / Province / Region

State / Province / Region

Seller's Zip / Postal Code

Zip / Postal Code

Seller's Country

Country

Buyer’s Info

Name and a complete address for the last known entity to whom the goods are sold or the owner if no purchase

Buyer's Company Name:

Buyer's Address

Buyer's Street Address*

Street Address

Buyer's Address Line 2

Address Line 2

Buyer's City

City

Buyer's State / Province / Region

State / Province / Region

Buyer's Zip / Postal Code

Zip / Postal Code

Buyer's Country

Country

Importer Information

IRS# or EIN# or Social Security#, Name and complete address

Importer Company Name:

Importer Address

Importer Street Address*

Street Address

Importer Address Line 2

Address Line 2

Importer's City*

City

Importer State / Province / Region

State / Province / Region

Importer Zip / Postal Code*

Zip / Postal Code

Importer's Country

Country

Consignee Information

IRS# or EIN or Social Security #, Name and complete address, must be a U.S. company

Consignee Company Name:

Consignee Address

Consignee Street Address*

Street Address

Consignee Address 2

Address 2

Consignee City*

City

Consignee State

State

Consignee Zip Code

Zip Code

Manufacturer / Supplier Information

Name and complete address of the entity that last manufactured/assembled/produced or grew the product or the party supplying the goods

Manufacturer / Supplier Company Name:

Manufacturer / Supplier Address

Manufacturer / Supplier Street Address*

Street Address

Manufacturer / Supplier Address Line 2

Address Line 2

Manufacture City

City

Manufacture State / Province / Region

State / Province / Region

Manufacture Zip / Postal Code

Zip / Postal Code

Manufacture Country

Country

Ship To Party

Name & complete address of 1st “deliver to” party scheduled to receive the goods after Customs Clearance

Ship To Party Company Name:

Ship To Party Address

Ship to Party Address

Street Address

Ship to Party Address 2

Address Line 2

Ship to Party City

City

Ship to Party State

State

Ship to Party Zip Code

Zip Code

Country of Origin:

Based on U.S. Customs Regulations

Description of product(s):

Commodity HTSUS# (Six digit classification#):*

Pro Forma Invoice

Max. file size: 128 MB.

Please attach a Pro Forma invoice copy so the harmonized numbers can be determined

Container Stuffing Location

Name and complete address of the physical location that the freight was loaded/stuffed in the container

Container Stuffing Location Company Name:

Container Stuffing Location Address

Container Stuffing Street Address

Street Address

Container Stuffing Address 2

Address Line 2

Container Stuffing City

City

Container Stuffing State / Province / Region

State / Province / Region

Container Stuffing Zip / Postal Code

Zip / Postal Code

Container Stuffing Country

Country

Consolidater

Name and complete address of the party that stuffed the container or arranged for the stuffing i.e. Forwarder

Consolidater Company Name:

Consolidater Address

Consolidater Street Address

Street Address

Consolidater Address Line 2

Address Line 2

Consolidater City

City

Consolidater State / Province / Region

State / Province / Region

Consolidater Zip / Postal Code

Zip / Postal Code

Consolidater Country

Country

Email

This field is for validation purposes and should be left unchanged.

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