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Personal Information:  
Your name:
Company name:
Address:
City:
State:
ZIP:
E-mail:
Phone number:
Customs Brokerage:  
Do you currently use a customs broker? Yes No
Type of customs entry:
Freight Forwarding:  
Method of transportation:
From (city / country):
To (city / country):
Product description:
Size & weight:
Value in US Dollars:
Letter of credit: Yes No
Insurance: Yes No
Hazardous cargo: Yes No
Terms:
Payment:
Additional information:

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