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 Letter of Instruction document. Please provide all information requested.

SHIP VIA
AIR FREIGHT CHARGES (Shipper must check one)
AIR FREIGHT CHARGES C.O.D. AMOUNT
SHIPPER'S REFERENCE NO.
CONSIGNEE'S REFERENCE NO.
SPECIAL INSTRUCTIONS
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)
DECLARED VALUE FOR CARRIAGE
SHIPPER REQUESTS INSURANCE	Yes No
INSURANCE AMOUNT

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 Letter of Instruction 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 Letter of Instruction document directly to the following Adcom Worldwide office:

"We sometimes ship items that are critical to the recipient hospitals or surgery centers and may be downright irreplaceable. Adcom is the only shipper I trust to get those items to their correct destination, on time, and in perfect condition."

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