Customer End-Use Certificate
Section A
Consignee Details
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
End-user details
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Supplier Details
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Section B
Description of the items
goods,software or technology
Value
Section C
Final Destination
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Notes
Section D
Intended end-use of items
Additional Notes
Submit
Should be Empty: