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Title 19Chapter IPart 141Subpart F → §141.85

Title 19: Customs Duties
Subpart F—Invoices

§141.85   Pro forma invoice.

A pro forma invoice submitted in accordance with any provision of this chapter shall be in substantially the following form:

Pro Forma Invoice

Importers Statement Of Value Or The Price Paid In The Form Of An Invoice

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

address ____________

Name of seller

address ____________;.

Name of consignee

address ____________.

Name of purchaser

address ____________.

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”)

(a) The price paid or agreed to be paid (_) as per order dated ______.

(b) Advices from exporter by letter (—) by cable (_) dated ______.

(c) Comparative values of shipments previously received (_) dated ______.

(d) Knowledge of the market in the country of exportation (_) ______.

(e) Knowledge of the market in the United States (if U.S. Value) (_) ______.

(f) Advices of the Port Director (_) ______.

(g) Other (_) ______.

A—Case marks numbersB—Manufacturer's item No. symbol or brandC—Quantities and full descriptionD—Unit purchase price (currency)E—Total purchase price (currency)F—Unit foreign valueG—Total foreign value

Check which of the charges below are, and which are not included in the prices listed in columns “D” and “E”:

AmountIncludedNot included
Wharfage and loading abroad
Ocean freight
U.S. duties
Other charges (identify by name and amount)

Country of origin ____________.

If any other invoice is received, I will immediately file it with the Port Director.


(Signature of person

making invoice)   


(Title and firm name)


[T.D. 73-175, 38 FR 17447, July 2, 1973, as amended by T.D. 85-39, 50 FR 9612, Mar. 11, 1985]

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