1. Shipper/Exporter

    Shipper/Exporter Street
        Shipper/Exporter City
Shipper/Exporter Province
    Shipper/Exporter Postal
2. Bill of lading number
3. Date
4. PRO number
5. P.O. Number
6. Ultimate Consignee
               Consignee Street
                  Consignee City
          Consignee Province
              Consignee Postal
Ultimate Consignee IRS number
7. Customs Broker
      Customs Broker Street
        Customs Broker City
 Customs Broker Province
     Customs Broker Postal
8. U.S. freight forwarder
U.S. freight forwarder Street
U.S. freight forwarder City
U.S. freight forwarder State
U.S. freight forwarder Zip
9. Country of origin
10. Point (State) of origin or FTZ number
11. Mode of transportation
12. Place of receipt by pre-carrier
13. Exporting carrier
14. U.S. port of export
  Purchase information only required if other than consignee
15. Purchaser's name
            Purchaser's Street
               Purchaser's City
        Purchaser's Province
            Purchaser's Postal
Particulars furnished by shipper
Pieces, description of commodities, marks numbers, kinds of packages
Schedule B
Classifiacation Number
Schedule B units
Gross weight
Unit price
Gross Weight
(U.S. dollars,
omit cents
Selling price or
Cost if not sold
Packaging Description
Total Weight (lbs)
Total Value
Domestic Freight (Check one)
International Freight (Check one)
Other Charges
Total extra charges
Invoice Total
U.S. Shipper
Email (this is where your copy of the paperwork will be sent)
Additional email to send paperwork to:
When you click "submit" a copy of the completed paperwork will be sent to the above email adresses as well as to Vision Transportation as well as any other required recipients.