See back of form for Paperwork Reduction Act Notice.
DEPARTMENT OF THE TREASURY
1. TYPE OF ACTION (mark all applicable)
Notification of importer's number
UNITED STATES CUSTOMS SERVICE
IMPORTER ID
INPUT RECORD
Check here it you also want your address updated in the Fines,
Penalties, and Forfeitures Office
Change of name*
FILL 2A OR 2B
19 CFR 24.5
2. IMPORTER NUMBER (Fill in one format):-
• NOTE--If a continuous bond is on file, a bond rider must accompany this change document.
2 B. Social Security Number
2A. I.R. S. Number
-
Check here if requesting a
2C.
Change of address
I have no IRS No.
Customs Assigned number and indicate reason (s). (Check all that apply)
2D. Customs-Assigned Number
I have no
Social Security No.
-
I have not applied for either number.
I am not a
U.S. resident.
RETURN TO :.
AWB REF #:
3 Importer Name
5. DIV/ AKA/ DBA Name
4. DIV AKA DBA
DIV
AKA
DBA
6. Type
Corporation
Partnership
Sole Proprietorship
Individual
Other
U.S. Government
7. Importer Mailing Address (2 32-character lines maximum)
9. State Code
8. City
10. ZIP
I 11. Country I SO Code (Non-U-S- Only)
12. Importer Physical Location Address (2 32-character lines maximum: see instructions)
13. City
ACCOUNT
14. State Code
-
-
15 . ZIP
16. Country ISO Code ( Non-U-S- Only)
17a. Has importer ever been assigned a Customs Importer Number using the same name as in Block 3 ? 17 b. Has importer ever been assigned a Customs Importer Number using a name different from that in Block 3?
No
Yes (List number(s) and or name(a) in Block 17 c-)
No
Yes (List number ) and or name(s) in Block I 7 c.)
17 c. If ''Yes' to 17a and/or 17 b, list number(s) and/or name(s)
NOTE: If the owner or ultimate consignee is a corporation this form must be signed by the president, vice president, secretary, or