CUSTOMS BOND DIRECT
                               

APPLICATION

PLEASE  ANSWER  FOLLOWING  QUESTIONS:

 
ABOUT YOUR COMPANY:
Company Style:
Individual
Partnership
Corporation
Sole Proprietorship
Your Company Name:
Company IRS# (or SSN):
Business Address:
  (City)
  (State) (Zip Code)
Company Residing Address:
(leave blank if same with above)  (City)
  (State) (Zip Code)
Incorporated State:
Telephone: - -
Fax: - -
 

            Describe Your Imported Merchandise

                 Country of Origin

1.

2.

3.

 
LAST CALENDAR YEAR ESTIMATE NEXT CALENDAR YEAR
Value Est. Duties No. Shipments Value Est. Duties No. Shipments
 Existing Bond?: With  Without
Bond Term Requested  1 Year           2 Year           3 Year
Bond Amount Requested: $50,000        $100,000
 Effective Date Requested:
With Any Default Claim?:
 
ABOUT YOURSELF:
Your Name: (First Name)
  (Last Name)
Title:
Telephone: - -