Shipping Declaration Form

Shipping Declaration Form
Shipper Information
Shipper's Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Consignee Information
Consignee's Full Name

First NameLast Name
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Shipment Details
Date of Shipment

MonthDayYear
Date
Method of Payment
Number of Packages
Type of Packaging

CartonPalletCrateOther
Total Weight (kg/lbs)
Description of Goods
Special handling instructions
Declared Value for Customs
Declared Value for Customs (With Original Receipt)
Declaration
I consent to screening of my cargo in compliance of federal regulations as stated in 49 CFR part 1500.
Date

MonthDayYear
Date
Signature

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Shipper Information