Version:clsd 2320 2023-01-25
This invoice must be completed in English.
COMMERCIAL INVOICE
Commercial Invoice 1 1
Page _______ of _______
EXPORTER: Ship Date:
Tax ID#: 24 Aug, 2023
Contact Name: Yurchic Nadiia Air Waybill No. / Tracking No.:
Telephone No.: 48459568844 773152942944
Invoice No.: Purchase Order No.:
E-Mail:
[email protected]Company Name/Address:
Payment Terms: Bill of Lading:
Yurchic Nadiia
ul. Konduktorska 39E
Purpose of Shipment:
SOLD
Pyrzowice 42625
Country/Territory: POLAND
Parties to Transaction:
Related X Non-Related
SOLD TO / IMPORTER (if different from Consignee):
CONSIGNEE:
Tax ID#: X Same as CONSIGNEE:
Contact Name: Brianna Alexander
Telephone No.: 13187946783 Tax ID#:
E-Mail:
[email protected]Company Name/Address: Company Name/Address:
Brianna Alexander
1423 ransbottom drive
alexandria LA 71302
Country/Territory: UNITED STATES OF AMERICA Country/Territory: UNITED STATES OF AMERICA
If there is a designated broker for this shipment, please provide contact information.
Name of Broker ____________________________________________________ Tel. No. __________________________ Contact Name ____________________________________________ ___
Duties and Taxes Payable by Exporter X Consignee Other If Other, please specify _______________________________________________________________________
No. of No. of Net Weight Unit of Harmonized Country/ Unit Total
Description of Goods
Packages Units (LBS / KGS) Measure Tariff Number Terr. of MFR Value Value
1 1.00 14.20 EA climbing triangle playroom (Not a toy) 4413000000 UA 90.000000 90.00
Total Total Total Net (Indicate Total Gross (Indicate Terms
Pkgs Units Weight LBS/KGS) Weight LBS/KGS) of Sale: Subtotal: 90.00
1 1.00 14.20 KG 14.20 KG Insurance: 0.00
Special Instructions:
Freight: 0.00
Manufacturer: Yurchic Nadiia
Lipkovskogo, 20 100 , Kiev, 03162, UA
Country of origin UA Packing: 0.00
Declaration Statement(s): 0.00
Handling:
I certify that all chemical substances in this shipment comply with all applicable rules or orders under TSCA and that I am not offering a chemical substance
for entry in violation of TSCA or any applicable rule or order thereunder. Other:
The goods in this parcel were not manufactured in or shipped from the Crimea, DNR or LNR (Donetsk and Luhansk regions) regions. Country of origin UA.
0.00
I declare that all the information contained in this invoice to be true and correct. Invoice Total: 90.00
Originator or Name of Company Representative if the invoice is being completed on behalf of a company or individual: USD
Currency Code:
Yurchic Nadiia
Date:
Signature / Title / Date: 24 Aug, 2023
REV. 08-23-22
