A pro forma invoice submitted in accordance with any provision of this chapter shall be in substantially the following form:
Not being in possession of a commercial seller's or shipper's invoice I request that you accept the statement of value or the price paid in the form of an invoice submitted below:
Name of shipper
Name of seller
Name of consignee
Name of purchaser
The merchandise (has) (has not) been purchased or agreed to be purchased by me.
The prices, or in the case of consigned goods the values, given below are true and correct to the best of my knowledge and belief, and are based upon: (Check basis with an “X”)
The price paid or agreed to be paid (_) as per order dated ______.
Advices from exporter by letter (—) by cable (_) dated ______.
Comparative values of shipments previously received (_) dated ______.
Knowledge of the market in the country of exportation (_) ______.
Knowledge of the market in the United States (if U.S. Value) (_) ______.
Advice by CBP (_) ______.
Other (_) ______.
Country of origin ____________.
If any other invoice is received, I will immediately file it with an authorized CBP official.
Date
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