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Canada Customs Invoice
 for
Display and Return Goods

Courtney Agencies Ltd.
Customs Brokers/Freight Forwarders
Phone: (604) 684-7505
Fax: (604) 683-7004
Toll Free Phone: 1-877-786-4970
Toll Free Fax: 1-800-956-8388
1. Shipper (Name and Address) 2. Date of Direct Shipment

3. Other References (Include Booth Number)
4. Ultimate Destination (Name and Address)

Customs Clearance by:
Courtney Agencies Ltd.
#8 - 14th Street, Blaine, Wa. 98230

Phone Toll free: (877) 786-4970
Toll Free Fax: (800) 956-8388

5. Name and Address of Exhibitor
7. Country of Origin of Goods If various, indicate various and include individual countries next to description
IF SHIPMENT INCLUDES GOODS OF DIFFERENT ORIGINS ENTER ORIGINS AGAINST ITEMS IN 12
8. Transportation:
Give Mode and Place of Direct Shipment to Canada 		9. Conditions of Sale and Terms of Payment
(i.e. Sale, Consignment Shipment, Leased Goods, etc. ) DISPLAY GOOD FOR TRADESHOW D8-1-1 9993 Code 51
10. Currency (ie: USD or CAD):
11. No. of Packages 12. Specification of Commodities
(Kind of Packages, Marks and Numbers, General Description and Characteristics, i.e. Grade, Quality)

13.  Quantity
(State Unit)

Value for Customs
14.   Unit Price 15.  Total

18. If any of fields 1 to 17 are included on an attached commercial invoice, check this box
Commercial Invoice No. 		16. Total Weight 17. Invoice Total
Net: Gross:
19. Exporter’s Name and Address
(If other than Shipper) 		20. Name and phone number of person completing form
(name)
(phone)
(e-mail)