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CLIENT INFORMATION SHEET
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CLIENT INFORMATION SHEET

Please take a moment to complete this form and include as much information as possible. This will help us establish a general view of your company and its activities. We shall be in contact with you shortly after we receive this form.

Please provide the following information:

Name
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
FAX
E-mail
URL
 
Product name
Tariff Numbers
 
Primary Business
Bond Type
Surety Name and Number
Importer Number
No.
Duty Payment Method
Security code:
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Haines International, Inc.
Last revised: July 1, 2004