Date:  Shipment Date

Your Company Name
Street Address
City
Postal Code
Country

Your Name
Telephone No.
 

TransFRESH Corporation 
3801-D Charter Park Court
San Jose, CA 95136
USA

Attn: Jan Torres
Ph. (408) 445 8861

Full Description of Goods

No of Units

Unit Weight

Weight (kg)

Unit Value (US$)

Value (US$)

TransFRESH Marine CA Controllers (Commodity Code 9032.89.6040) 

9801 U.S. GOODS RETURNED 

12

3.0kg (6.5lb)

 36

$781.92

 $9383

Country of Origin:               USA

Total Weight:   36

Total Value:   $9383

 No of Packages:                3

 FedEx Air Waybill No:    9999 8888 77776

NOTE: NO COMMERCIAL VALUE - Goods Not for Resale

Goods are for use in marine shipping containers for perishable fruits and vegetables. Being returned to owners.

I certify that the information on this declaration is true and correct to the best of my knowledge.
 

Name:   Print Your Name                             Signature:___Sign Here ________