Adcom Worldwide - Customer Education Center

The information gathered in the following fields will be used to generate a completed PDF copy of the Shipper's Export Declaration document. Please provide all information requested.

1a. U.S. PRINCIPLE PARTY IN INTEREST (USPPI) (Complete name and address)
ZIP CODE
1b. USPPI EIN (IRS) OR ID NO.
1c. PARTIES TO TRANSACTION	Related Non-related
2. DATE OF EXPORTATION
3. TRANSPORTATION REFERENCE NO.
4a. ULTIMATE CONSIGNEE (Complete name and address)
4b. INTERMEDIATE CONSIGNEE (Complete name and address)
5a. FORWARDING AGENT (Complete name and address)
6. POINT (STATE) OF ORIGIN OR FTZ NO.
7. COUNTRY OF ULTIMATE DESTINATION
8. LOADING PIER (Vessel only)
9. METHOD OF TRANSPORTATION (Specify)
10. EXPORTING CARRIER
11. PORT OF EXPORT
12. PORT OF UNLOADING (Vessel and air only)
13. CONTAINERIZED (Vessel only)	Yes No
14. CARRIER IDENTIFICATION CODE
15. SHIPMENT REFERENCE NO.
16. ENTRY NUMBER
17. HAZARDOUS MATERIALS	Yes No
18. IN BOND NUMBER
19. ROUTED EXPORT TRANSACTION	Yes No
Fields 20-26* (SCHEDULE B DESCRIPTION OF COMMODITIES) will be completed below.*
27. LICENSE NO / LICENSE EXCEPTION SYMBOL / AUTHORIZATION
28. ECCN (When required)
29. Duly authorized officer or employee
30. Title
Telephone No. (Include Area Code)
E-mail Address
31. AUTHENTICATION (When required)

After you have completed the fields above, you must provide the SCHEDULE B DESCRIPTION OF COMMODITIES. For each line item in this section, complete the fields below and click the Add Line Item button. When all line items have been added, continue with form submission below.

D/F or M (21)	D/F M
SCHEDULE B NUMBER (22)
QUANTITY SCHEDULE B UNIT(S) (23)
SHIPPING WEIGHT (Kilograms) (24)
VIN / PRODUCT NUMBER / VEHICLE TITLE NUMBER (25)
VALUE (U.S. dollars, omit cents) (Selling price or cost if not sold) (26)

When the information above is correct and complete, click the Submit Form button below to generate a PDF copy of the completed Shipper's Export Declaration document for printing and/or download. You can also choose to forward a copy of the completed document directly to Adcom Worldwide by checking the box below. Please note that you will need to print and sign this form before faxing it to us.

I would like to email a copy of the Shipper's Export Declaration document directly to the following Adcom Worldwide office:

"Adcom seems to be able to create solutions to help solve all of our technology shipping issues."

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