Chemical Import Single Entry Declaration Form
Use this form to submit the details needed for a single chemical import entry declaration, including importer information, shipment details, and supporting documents.
Importer and Entry Details
Importer/Company Name
*
Contact Person Name
*
First Name
Middle Name
Last Name
Contact Email
*
example@example.com
Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Single Entry or Declaration Reference Number
*
Chemical Shipment Details
Chemical / Product Name
*
Chemical Type or Category
*
Please Select
Industrial Chemical
Laboratory Reagent
Solvent
Acid
Base
Oxidizer
Flammable Liquid
Compressed Gas
Other
Quantity to be Imported
*
Unit
*
Please Select
kg
g
mg
L
mL
tonnes
drums
bags
containers
Other
Country of Origin
*
Please Select
Afghanistan
Albania
Algeria
Argentina
Australia
Austria
Bangladesh
Belgium
Brazil
Canada
China
France
Germany
India
Indonesia
Italy
Japan
Malaysia
Mexico
Netherlands
Pakistan
Singapore
South Africa
South Korea
Spain
Thailand
Turkey
United Kingdom
United States
Other
Expected Arrival Date
*
-
Month
-
Day
Year
Date
Port / Point of Entry
*
Declaration and Supporting Documents
Declaration acknowledgment
*
I confirm the information provided is accurate
I confirm this shipment is for a single import entry
Supporting documents
*
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Additional notes or remarks
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