Drawback Qualification Questionnaire

Company Name:
Contact Name:
Phone Number:
E-mail:


1)	Briefly describe the nature of your business:


2)	How much duty have you paid each of the last three years?
	Year 1:*
	Year 2:*
	Year 3: projected

3)	Do you import and pay duty directly? If so, please indicate the percentage.
	Yes. Percentage: % No.

4)	Do you purchase imported material from domestic vendors? If so, please indicate the percentage.
	Yes. Percentage: % No.

5)	Please describe the primary articles and/or raw materials that you import:


6)	How many part numbers do you import?


7)	Customs broker(s) used for importing:


8)	What are your average number of import shipments on a monthly basis and what are the average number of invoice line items for each import shipment?
	Average Number of Shipments:
	Average Number of Invoice Line Items:

9)	If the imported materials undergo a manufacture process prior to export, please describe this process:


10)	What is the approximate ratio of your export to your domestic sales?


11)	Please list your primary export destinations:


12)	Do you export to Canada and/or Mexico?
	Yes. No.
	If yes, what percentage do these destinations represent? %

13)	Do you generate your export invoices on a system?
	Yes. No.
	Can you retrieve this information for each of the past three years?
	Yes. No.

14)	What are the average number of line items on one of your export invoices?


15)	Are you the exporter or record, i.e. do you appear as the shipper on the export bill of lading?
	Yes. No.

16)	Do you maintain copies of export bills of lading and commercial invoices?
	Yes. No.
	If yes, are these records available for the past three years of export activity?
	Yes. No.

17)	If applicable can you provide bills of material and exports in an electronic format?
	Yes. No.