PROFORMA INVOICE
Export References:
Expiration Date: 1FEB09
Sold To Name and Address:
Medical Imaging Minnesota, Inc. quote number BT10102 Mendez Equipo Médico S.A. purchase order number M3652
Exporter Name and Address: Ultimate Consignee Name and Address:
Medical Imaging Minnesota, Inc 100 North Sixth Street Minneapolis, MN 55403 USA
Mendez Equipo Médico S.A. Col. Roma Mexico D.F., C.P. 06760
Mendez Equipo Médico S.A. Col. Roma Mexico D.F., C.P. 06760
Intermediate Consignee/Consigned to:
Notify Party Name and Address:
Date of Shipment: 3 - 4 Weeks from Order AWB/BL Number: Currency: USD Letter of Credit Number:
Galfiro Montemayor Brokers Avenida de Colombia 1025 Veracruz, Mexico
Mendez Equipo Médico S.A. Col. Roma Mexico D.F., C.P. 06760 Phone: 5 25 1 348 1572 Contact: Carlos Mendez Transportation method:
Conditions of Sale and Terms of Payment:
Freight (please mark): Pre-paid X Collect___
Title Transfer Occurs At: Minneapolis, Minnesota CPT Veracruz, Mexico per Incoterms 2000 Payment Terms: Payable by letter of credit
Total Number of Packages: 4 Via: Ocean From: Port of Houston, Texas to Port of Veracruz, Mexico Total Net Weight (kgs): 1,820 Total Gross Weight (kgs): 2,000
Item Number, Product Description, Tariff Classification Number, Country of Origin Model BT002043 Ultrasound Imaging Machine Tariff Classification 9018.12 USA origin
Quantity
Unit Price
Total Price
4
80,000
320,000 USD
Export Packing/Crating U.S Inland freight: Minneapolis to Houston Forwarding fees Ocean freight
800 300 240 6,060
Total CPT Veracruz, Mexico per Incoterms 2000
USD 327,400
Please Note: These commodities, technology, or software were exported from the United States in accordance with the Export Administration Regulations. Diversion contrary to U.S. law prohibited.
Authorized Signature: Name: Ms. Amelia Goeppinger Date: 10JAN08 Company: Medical Imaging Minnesota, Inc. Title: Export Manager
E-mail: agoeppinger@mim.com
Telephone Number(s) Voice: 987 654 3210
Facsimile: 987 654 3211
This invoice is for export/import purposes only and not intended for payment purpose
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