Drawback Potential
(415) 460-6500

1) Briefly describe the nature of your business:

2) How much duty have you paid each of the last three years?

3) Do you import and pay duty directly, or do you purchase imported material from domestic
vendors? (If you do both, please indicate the percentage for each)

Import and pay duty directly
Purchase imported material from domestic vendors
% Imported and paid directly
% Purchased imported materials from domestic vendors

4) Please describe the primary articles and/or raw materials that you import:

5) How many part numbers do you import?

6) Customs broker(s) used for importing:

7) What are your average number of import shipments on a monthly basis and what are the
average number of invoice line items for each import shipment?

Average Number of Shipments:

Average Number of Invoice Line Items:

8) If the imported materials undergo a manufacture process prior to export, please describe
this process:

9) What is the approximate ratio of your export to your domestic sales?

10) Please list your primary export destinations:

11) Do you export to Canada and Mexico?

Yes No

If yes, what percentage do these destinations represent?
%

12) Do you generate your export invoices on a system?

Yes No

Can you retrieve this information for each of the past three years?

Yes No

13) What are the average number of line items on one of your export invoices?

14) Are you the exporter of record, i.e. do you appear as the shipper on the export bill of lading?

Yes No

15) Do you maintain copies of export bills of lading and commercial invoices?

Yes No

If yes, are these records available for the past three years of export activity?
Yes No

16) If applicable, can you provide bills of material and exports in an electronic format?

Yes No