Invoice
Page 1
Invoice Number (Reference 1):
Purchase Order Number (Reference 2):
Postal Code Country/Territory:
Terms of Sale (Incoterm):
Postal Code Country/Territory:
Postal Code Country/Territory:
Description of Goods/Part Number
Invoice Line total: ____________________________
Discount/Rebate:
Invoice Sub-Total: ____________________________
Freight:
Insurance:
Other:
Total Invoice amount:
Shipper's Signature / Title Date Total Number of Packages:
Total Weight:
These items are controlled by the U.S., E.U., & other gov'ts, & authorized for export only to the country of ultimate destination for use by
the ultimate consignee or end-user(s) herein identified. They may not be resold, transferred, or otherwise disposed of, to any other
country or to any person other than the authorized ultimate consignee or end-user(s), either in their original form or after being
incorporated into other items, without first obtaining approval from the U.S., E.U. & other gov'ts, or as otherwise authorized by those
gov't's law & regulations.