Name:
DBA:
Physical Address:
Billing Address if different:
Phone:
Fax:
Accounting Contact:
Number of Years in Business:
Corporation or LLC in:
EIN:
SSN if Individual or Partnership:
Referred by:
Have you contacted one of our offices?
Have you imported into the US before? Yes No
Insert your initials to approve the credit search required by CBP and TSA:
Your Website:
Owner / President / Principal:
Owner Email:
Name of Contact for Imports:
Import Contact Email
Other Contact Email
Name of AES Export Contact
AES Export Contact Email
After Hours Contact:
After Hours Phone Number:

Customs Information

Do you have a continuous bond with Customs? Yes No If no, we will tender a single transaction bond for each import transaction.
If no, do you want Charles M Schayer to apply for a continuous bond with Customs for you? Yes No
Approximate number of imports — per Week Month Year
Are you C-TPAT certified? Yes No
HTS or Binding Ruling numbers:
Your ACH number:
Type of Goods:
Import from:

Export, AES, and TSA Air Security Information

Type of Goods:
Export to:
Are your goods licensable? Yes No
HTS:
Number of Exports per Week Month Year If applicable, insert your initials after reading this Air Export Certification to certify that you have read it. "I certify that I am aware of IATA Dangerous Goods Regulations, US DOT Hazardous Materials Regulations and TSA Security rules, and that the cargo I will be shipping will not contain any undeclared or unauthorized explosives, incendiaries, or hazardous materials. I consent to a search and/or screening of my cargo. I acknowledge this endorsement and original signature, along with other shipping documents, will be retained on file and made available to the TSA, DHS and/or FBI." Insert your initials to certify that you have read the preceeding statement:

Insurance Information

Are your shipments covered by door-to-door cargo insurance? Yes No
Do you want to insure under our blanket policy? Yes No

Delivery Instructions

Do you have a preferred trucker or carrier? Yes No If yes, what is your preferred trucker or carrier? If you have no preferred trucker or carrier, you hereby authorize us to select a truckman, without liability, as an independent contractor.
Our shipment should be: Prepaid Collect

Consent

Please note that comments, classification or other opinions offered by our staff during the routine processing of shipments will be based on whatever information is available to them at that time. These comments, classifications or other opinions are not binding and require verification for compliance to avoid potential liability with US Customs. Adequate review, required under the "Reasonable Care" guidelines has not been undertaken and needs to be performed separate from the time of routine import or export transactions. Please contact our Compliance office by email for details or to schedule required processing. Your typed signature here acknowledges that you have read our Terms and Conditions.
Printed Signature:
Capacity or Title:
Date (mmddyyyy):
Which Charles M Schayer & Company office should receive this profile? Please email a legible copy of signer's driver's license or other photo ID to Charles M Schayer & Company — or mail a printed copy bearing a signature that is obviously original to Charles M Schayer & Company, 3839 Newport Street, Denver, Colorado 80207.

Additional Questions

Is there a relationship between you (the importer) and the exporter, either by ownership interest (capital investment) or blood? Yes No
Is a buying commission paid to a foreign or domestic buying agent? Yes No
Are any payments made or incurred by you (the importer) in the U.S. or abroad, for engineering, molds, tools, designs, research and development, raw materials, or components utilized in the manufacture of the imported merchandise? Yes No
Does the imported merchandise bear a copyright, trademark or trade name, whether owned by you, the importer or others? Yes No
Are any royalty payments made in the U.S. or abroad in connection with trademarks, trade names, or patents related to the imported merchandise? Yes No
Are any post-import installation charges included in the invoice price? Yes No
Are there any other payments or discounts, other than those specified above, related to the imported merchandise, that are not included in the invoice presented to Customs? Yes No
Is merchandise purchased on any basis other than ex-factory prices? Yes No
Are there financing arrangements relating to the merchandise other than payment by letter of credit? Yes No
Do you pay financing charges to the exporter in connection with the shipment? Yes No
Is more than one country involved in the production of the imported merchandise? Yes No
Is the marking of the country of origin on the imported merchandise obscure, confusing or temporary? Yes No
Are you importing goods that could be entitled to entry under the Generalized System of Preferences, Israeli Trade Agreement, Caribbean Basin Initiative, or African Growth and Opportunity Act (AGOA)? Yes No
Are imported products received that are found to be defective or not up to specifications? Yes No
Is the price of merchandise ever reduced after importation with the rebate credited against the price of future shipments? Yes No
Does the exporter receive any portion of the post-importation sales proceeds? Yes No
Have you applied for or obtained any binding classification rulings from the US Customs Service? Yes No
Are imported products exported, either in the same condition or after incorporated into other articles? Yes No
Are domestically manufactured items shipped abroad and subsequently re-imported into the US as a part of the imported product? Yes No
Do you consider the quantity, value, or exporter's name to be confidential? Yes No
Are there any countervailing or anti-dumping duty investigations underway that may affect any of the imported products or suppliers? Yes No
Are your suppliers currently participants in the Customs Trade Partnership Against Terrorism (C-TPAT) program? Yes No
Are you aware of and ready to comply with the Importer Security Filing rule that became effective on January 26, 2009. Yes No
If you need a Customs bond for single entry, continuous, or ISF purposes, do any of the following conditions apply? • Currently on sanction? • Filed bankruptcy? • Pending bond claims? • Prior fraud or negligence? • Paid bond claims? Yes No

Charles M Schayer & Company — New Client Profile

Customs Information

Export, AES, and TSA Air Security Information

Insurance Information

Delivery Instructions

Consent

Additional Questions