FPA Customs Brokers Inc.
ISF Filing Input Worksheet
Importer Security Filing
"10 + 2"
Master B/L: ______________________House B/L:___________________ ETD: ________
AMS NO: S
______________________ cac Code:___________________ ETA: ________
Vessel: ______________________
Carrier: ______________________
Importer of Record Manufacturer/Supplier Ship to/Deliver to
the entity that last manufactured, assembled, produced,
Federal ID#, name and address of importer
or grew the commodity or the supplier of the finished the first known location or delivery to party to
IRS No.: goods physically receive the goods
Name: Name: Name:
Address: Address: Address:
City: City: City:
Country: Country: Country:
Seller Container Stuffing Location Consignee
FEDERAL ID# NAME AND ADDRESS OF THE
LAST KNOW ENTITY BY WHOM THE GOODS PHYSICAL LOCATION WHERE THE GOODS WERE ULTIMATE CONSIGNEE TO PHYSICALLY
ARE SOLD OR AGREED TO BE SOLD LOADED INTO A CONTAINER FOR SHIPPING RECEIVE THE GOODS
Name: Name: IRS #:
Address: Address: Name:
Address:
City: City: City:
Country: Country: Country:
Buyer Consolidator/Stuffer Country of Origin
Last know entity to whom the goods are sold or the name and address of the party that loaded the country of manufacture, production or growth of
agreed to be sold container or arranged for the loading of the container any article of foreign origin entering the U.S.
Name: Name:
Address: Address: Country:
City: City:
Country: Country:
DETAILED DESCRIPTION OF GOODS: ETD: COMMODITY/HTS#:
DESCRIPTION OF GOODS WITH FIBER CONTENTS, KNIT OR WOVEN, ETC. CURRENT HTS # OF GOODS/CONTAINER
***** Please note FPA Customs Brokers will not be responsible for any misinformation in filing as this form must be reviewed and filled out
accordingly as per the requirements in place by U.S. Customs and Border Protection before filing. Any Penalties will be directed to the importer of record.****