Customs Declaration Agent Authorization Form
Complete the Customs Declaration Agent Authorization Form to designate an agent to prepare, submit, and communicate on your behalf for a customs declaration.
Applicant Full Name
*
First Name
Last Name
Applicant Email Address
*
example@example.com
Applicant Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Agent/Representative Full Name
*
First Name
Last Name
Agent/Representative Company Name
*
Agent/Representative Email Address
*
example@example.com
Agent/Representative Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Shipment Description (goods, quantity, etc.)
*
Expected Date of Customs Declaration
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Applicant Signature (to authorize agent)
*
Submit Authorization
Submit Authorization
Should be Empty: