International Shipping Form

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Export Shipping Form/Commercial Invoice

Form Completion Instructions

Equipment, materials and documents may not be sent outside the country until the ORSP Research Compliance Coordinator determines if an export control license or other agreement is required to ship the item. The information provided on this form is used to help make these determinations. If a license or agreement is required, it can take up to 6 months to obtain one.

Complete one form for items shipped to the same address.
Due to the nature of the information collected, the person on whose behalf the shipment is made must complete Parts A, B, C, D and E of this form.

Questions on Shipping Internationally: Email Mail Operations or call 590-1319

Contact Environmental Health & Safety at 590-1414 (ehs@fgcu.edu) for packing instructions of hazardous materials.

Part A: FGCU Shipper Information

Name*

Prefix (optional)

First Name

Last Name

Phone*

College/Office*

Department/Division*

Email*

PO/Grant #

(if applicable)

Purpose of Shipment*

Part B: Recipient Information

Company/Institution

Department

Recipient Name*

Prefix (optional)

First Name

Last Name

Recipient Email

(if applicable)

Recipient Phone

Include country code

Address Line 1*

Address Line 2

City, State, ZIP (City, Region, Postal Code)*

This information is for review purposes only. Does not need to be in mailing format.

Country*

Intended Use by Recipient*

The application or function for which the item(S) shipped will ultimately be utilized.

Part C: Item(s) Being Shipped

Number of Items Being Shipped*

1 Item 2 Items 3 Items 4 Items 5 Items

Item #1 Description*

Include Part/Model Number if applicable

Item #1 Quantity*

Item #1 Unit of Measure

Item #1 Weight

Indicate grams, kilograms, ounces, pounds

Item #1 Unit Cost $

In U.S. Dollars

Item #1 Country of Origin

Item #2 Description*

Include Part/Model Number if applicable

Item #2 Quantity*

Item #2 Unit of Measure

Item #2 Weight

Indicate grams, kilograms, ounces, pounds

Item #2 Cost $

In U.S. Dollars

Item #2 Country of Origin

Item #3 Description*

Include Part/Model Number if applicable

Item #3 Quantity*

Item #3 Unit of Measure

Item #3 Weight

Indicate grams, kilograms, ounces, pounds

Item #3 Cost $

In U.S. Dollars

Item #3 Country of Origin

Item #4 Description*

Include Part/Model Number if applicable

Item #4 Quantity*

Item #4 Unit of Measure

Item #4 Weight

Indicate grams, kilograms, ounces, pounds

Item #4 Cost $

In U.S. Dollars

Item #4 Country of Origin

Item #5 Description*

Include Part/Model Number if applicable

Item #5 Quantity*

Item #5 Unit of Measure

Item #5 Weight

Indicate grams, kilograms, ounces, pounds

Item #5 Cost $

In U.S. Dollars

Item #5 Country of Origin

Part D: Shipping and Billing Information

Contact Environmental Health & Safety at 590-1414 (ehs@fgcu.edu) for packing instructions of hazardous materials.

Federal Express Services*

International Priority International Economy

Total Declared Value* $

What would the value of your item(s) be if you had to replace it.

Bill to*

Sender (Indicate Banner Index #) Recipient (Indicate FedEx Account #) Third Party (Indicate FedEx Account #)

Sender's Banner Index #

Recipient's FedEx Account #*

Third Party's FedEx Account #*

Name of Individual Authorizing Payment*

Prefix (optional)

First Name

Last Name

Part E: Signature

Once you submit this form, you may NOT go back to make changes. You can use the Save and Resume Later link below to make changes prior to submitting to the form.

Note: Attachments will only be saved upon final submission of the form.

Signature*

[clear]

Use your mouse or finger to draw your signature above

Date/Time*

Compliance Use Only

Export Control Numbers for Customs Purposes*

EAR ECCN# ITAR/Category HTS/Schedule B# AES ITN# License or Exception Other None of these

EAR ECCN#*

ITAR/Category*

HTS/Schedule B#*

AES ITN#*

As required

License or Exception*

Other*

Notes

Research Compliance Office*

[clear]

Use your mouse or finger to draw your signature above

Date*