Courtney Agencies Ltd. || Canada Customs Invoice for Display and Return Goods

1. Shipper (Name and Address)

4. Ultimate Destination (Name and Address)

Customs Clearance by:
Courtney Agencies Ltd.
#8 - 14th Street, Blaine, Wa. 98230

Phone Toll free: (877) 786-4970
Toll Free Fax: (800) 956-8388

8. Transportation:
Give Mode and Place of Direct Shipment to Canada

2. Date of Direct Shipment

3. Other References (Include Purchaser’s Order No.)

5. Name and Address of Exhibitor

7. Country of Origin of Goods

IF SHIPMENT INCLUDES GOODS OF DIFFERENT ORIGINS ENTER ORIGINS AGAINST ITEMS IN 12

(i.e. Sale, Consignment Shipment, Leased Goods, etc. ) Giveaway (printed matter, etc) for Tradeshow
Applicable duties and taxes apply

10. Currency (ie: USD or CAD):

16. Total Weight	17. Invoice Total
Net: Gross:

11. No. of Packages	12. Specification of Commodities (Kind of Packages, Marks and Numbers, General Description and Characteristics, i.e. Grade, Quality)	13. Quantity (State Unit)	Value for Customs
11. No. of Packages		13. Quantity (State Unit)	14. Unit Price	15. Total

18. If any of fields 1 to 17 are included on an attached commercial invoice, check this box

Commercial Invoice No.

19. Exporter’s Name and Address
(If other than Vendor)

20. Originator (Name and Address)
(name)
(phone)
(e-mail)

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