
Revenue Canada Customs and Excise CANADA CUSTOMS INVOICE Page____
Revenu Canada Douanes et Accise FACTURE DES DOUANES CANADIENNES of/de____
1. Vendor (Name and Address)/ Vendeur (Nom et adresse)
2. Date of Direct Shipment to Canada/ Date d!expedition directe vers le Canada
3. Other References (Include Purchaser’s Order No.)
Autres references (Inclure le n° de commande de l!acheteur)
4. Consignee (Name and Address/ Destinataire (Nom et adresse)
5. Purchaser’s Name and Address (If other than Consignee)
Nom et adresse de l!acheteur (S!il differe du destinataire)
6. Country of Transhipment/ Pays de transbordement
7. Country of Origin of Goods
Pays d!origine des marchandises
IF SHIPMENT INCLUDES GOODS OF DIFFERENT
ORIGINS, ENTER ORIGINS AGAINST ITEMS IN 12
SI L!EXPEDITION COMPREND, DES
MARCHANDISES D!ORIGINS DIFFERENTES,
PRECISER LEUR PROVENANCE EN 12
8. Transportation: Give Mode and Place of Direct Shipment to Canada
Transport: Preciser mode et point d!expedition directe vers le Canada
9. Conditions of Sale and Terms of Payment
(i.e. Sale, Consignment Shipment, Leased Goods, etc.)
Conditions de vente et modalites de paiement
(p. ex. vente, expedition en consignation, location de marchandises, etc.)
10. Currency of Settlement/ Devises du paiement
11. No. of
Pkgs/ N bre
de colis
12. Specification of Commodities (Kind of Packages, Marks and Numbers, General
Description and Characteristics, i.e. Grade, Quality)
Designation des articles (Nature des colis, marques et numeros, description
generale et caracteristiques, p. ex. classe, qualite)
13. Quantity
(State Unit)
Quantite
(Preciser l!unite)
Selling Price/ Prix de vente
14. Unit Price
Prix unitaire
18. If any of fields 1 to 17 are included on an attached commercial invoice, check this box
Si les reseignements des zones 1 a 17 figurent sur la facture commerciale, cocher cette boite
Commercial Invoice No/ N’ de la facture commerciale
16. Total Weight/ Poids Total
17. Invoice Total
Total de la facture
19. Exporter’s Name and Address (If other than Vendor)
Nom et adresse de l!exportateur (S!il differe du vendeur)
20. Originator (Name and Address)/ Expediteur d!origine (Nom et adresse)
21. Departmental Ruling (If applicable)/ Decision du Ministere (S!il y a lieu)
22. If fields 23 to 25 are not applicable, check this box
Si les zones 23 a 25 sont sans objet, cocher cette boite
23. If included in field 17 indicate amount:
Si compris dans le total a la zone 17, preciser:
(i) Transportation charges, expenses and insurance from the
place of direct shipment to Canada
Les frais de transport, depenses et assurances a partir du
point d!expedition directe vers le Canada
$
(ii) Costs for construction, erection and assembly incurred
after importation into Canada
Les couts de construction, d!erection et d!assemblage apres
importation au Canada
$
(iii) Eport packing/ Le cout de l!emballage d!exportation $
$
24. If not included in field 17 indicate amount:
Si non compris dans le total a la zone 17, preciser:
(i) Transportation charges, expenses and insurance to the
place of direct shipment to Canada
Les frais de transport, depenses et assurances a jusqu!au
point d!expedition directe vers le Canada
$
(ii) Amounts for commissions other than buying
commissions
Les commissions autres que celles versees pour l!achat
$
(iii) Eport packing/ Le cout de l!emballage d!exportation
$
25. Check (If applicable):
Cocher (S!il y a lieu):
(i) Royalty payments or subsequent proceeds are paid or
payable by the purchaser
Des redevances ou produits ont ete ou seront verses par
l!acheteur
(ii) The purchaser has supplied goods or services for use in
the production of these goods
L!acheteur a foumi des marchandises ou des services pour
la production des marchandises
DEPARTMENT OF NATIONAL REVENUE—CUSTOMS AND EXCISE MINISTERE DU REVENU NATIONAL—DOUANES ET ACCISE