Government Confidentiality Request Form -

Variations of the Importers (#40)

Requester Contact Information

First Name

Last Name

Phone number

Please provide the list of any variations (up to 10) that would be provided on documentation for your company’s name by your shippers. We will need the complete name and address for each of the variations on your company’s name.

Enter the company´s name as shown as consignee on the Bill of Lading.

Company name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have additional company name or additional variations of how your company name is shown on the Bill of Lading?

Yes

Second variation of the company name

Company name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have a third variation of the company name?

Yes

Third variation of the company name

Company name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have a fourth variation of the company name?

Yes

Fourth variation of the company name

Company

Address

Address Line 1

Address line 2

City

State

ZIP Code

Country

Do you have a fifth variation of the company name?

Yes

Fifth variation of the company name

Company name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have a sixth variation of the company name?

Yes

Sixth variation of the company name

Company name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have a seventh variation of the company name?

Yes

Seventh variation of the company name

Company name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have an eighth variation of the company name?

Yes

Eighth variation of the company name

Company name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have an ninth variation of the company name?

Yes

Ninth variation of the company name

Company name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have a tenth variation of the company name?

Yes

Tenth variation of the company name

Company name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

SHIPPER VARIATIONS

Please provide the list of any variations (up to 10) that would be provided on documentation for the shippers that you import with. We will need the complete name and address for each of the variations of the shippers' names.

Enter the company´s name as shown as shipper on the Bill of Lading

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have additional shippers or additional variations of how your shipper is shown on the Bill of Lading?

Yes

Second shipper or variation on shippers name

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have a third shipper or variation on shippers name?

Yes

Third shipper or variation on shippers name

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have a fourth shipper or variation on shippers name?

Yes

Fourth shipper or variation on shippers name

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have a fifth shipper or variation on shippers name?

Yes

Fifth shipper or variation on shippers name

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have a sixth shipper or variation on shippers name?

Yes

Sixth shipper or variation on shippers name

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have a seventh shipper or variation on shippers name?

Yes

Seventh shipper or variation on shippers name

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have an eighth shipper or variation on shippers name?

Yes

Eighth shipper or variation on shippers name

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have a ninth shipper or variation on shippers name?

Yes

Ninth shipper or variation on shippers name

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Do you have a tenth shipper or variation on shippers name?

Yes

Tenth shipper or variation on shippers name

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country