A link to the Portable Document Format (PDF) of this form is provided below. The content of the form is duplicated in HTML following the PDF link.
Not for inland clearance
Note: Complete both sections I and II below
Section I: Conveyance information
- 1. Consignee name and address (Must be Chrysler, Ford, or GM)
- 2. Carrier name
- 3. U.S. port of exit
- 4. Date of border crossing (YYYY-MM-DD)
- 5. Country of origin
- 6. Release office
- 7. Master bill of lading No.
- 8. Carrier code
- 9. Trailer/railcar No.
Section II: Supplier shipment information
Special Instructions – Complete a separate line for each SID or packing slip on the shipment.
- Description of goods – Select the appropriate codes to complete the commodity code column
- A Power train components
- B Chassis components
- C Steering components
- D Suspension components
- E Brake components
- F Fasteners and fittings
- G Electrical components
- H Body stampings
- I Body trim and glass components
- J Body hardware and accessories
- K Trim
- L Paints, chemicals and lubricants
- Other - specify
- 10. Shipping date (YYYY-MM-DD)
- 11. Packing slip — SID No.
- 12. Supplier code or name
- 13. Supplier city and state
- 14. Prod. / Serv.
- 15. No. of packages
- 16. Weight
- 17. Plant code
- 18. Commodity code
- 19. Driver's name (print) -
- 20. Driver's signature
- 21. Page (number) of (number)
Use this form only for production and servicee parts arriving via highway and destined for Chrysler Canada Ltd., Ford Motor Company of Canada Limited, and General Motors of Canada Limited.
Do not use this form for non-production parts - i.e.; machinery; equipment; prototype or pilot; parts empty racks; miscellaneous goods (e.g., gloves, tools, blueprints, computers).
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