Importer Identity Information Form

Company Name

Business Registration Number

Business Type

Registered Business Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Country of Importer

Authorized Representative Full Name

First NameLast Name

Position/Title of Authorized Representative

Business Email Address

example@example.com

Business Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Types of Goods Imported

Main Countries of Origin for Imports

Company Website (if applicable)

Additional Comments or Notes