OMB NO Form: 0625-0259
Expire: December 31,2009
Application for Cement Import License
All fields are required except Customs Entry Number and those fields for products Two and Three.
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Applicant Information
Company Name:
Address 1:
Address 2:
City:
State:
Zip:
Contact Name:
Contact Phone:
Contact Fax:
Contact Email:
Import/Export Information
Importer Name:
Exporter Name:
Manufacturer Name:
Country of Origin:
Country of Exportation:
Expected Port of Entry:
---- Please select from list ----
ALGERIA
ANGOLA
ANTIGUA AND BARBUDA
ARGENTINA
ARUBA
AUSTRALIA
AUSTRIA
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BOLIVIA
BOSNIA-HERCEGOVINA
BOTSWANA
BRAZIL
BRITISH VIRGIN ISLANDS
BULGARIA
BURKINA FASO
BURMA (MYANMAR)
BURUNDI
CAMEROON
CANADA
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
COLOMBIA
CONGO (Brazzaville)
CONGO (Kinshasa)
COSTA RICA
COTE D IVOIRE
CROATIA
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
ECUADOR
EGYPT
EL SALVADOR
ESTONIA
FALKLAND ISLANDS
FEDERAL REPUBLIC OF GERMANY
FIJI
FINLAND
FRANCE
GABON
GAMBIA
GEORGIA
GHANA
GREECE
GRENADA
GUATEMALA
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN
IRELAND
ISRAEL
ITALY
JAMAICA
JAPAN
JORDAN
KAZAKHSTAN
KENYA
KIRIBATI
KOREA
KUWAIT
KYRGYZSTAN
LATVIA
LESOTHO
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAO
MACEDONIA (SKOPJE)
MADAGASCAR
MALAWI
MALAYSIA
MALI
MALTA
MAURITANIA
MAURITIUS
MEXICO
MOLDOVA
MONACO
MONGOLIA
MONTSERRAT
MOROCCO
MOZAMBIQUE
NAMIBIA
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NIGER
NIGERIA
NORFOLK ISLAND
NORWAY
OMAN
PAKISTAN
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
POLAND
PORTUGAL
ROMANIA
RUSSIA
RWANDA
SAN MARINO
SAO TOME AND PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA AND MONTENEGRO
SIERRA LEONE
SINGAPORE
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOUTH AFRICA
SPAIN
SRI LANKA
Steel Only
ST. KITTS AND NEVIS
ST. LUCIA
ST. VINCENT AND THE GRENADINES
SURINAME
SWAZILAND
SWEDEN
SWITZERLAND
SYRIA
TAIWAN
TANZANIA
THAILAND
TOGO
TOKELAU
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES
URUGUAY
VENEZUELA
VIETNAM
ZAMBIA
---- Please select from list ----
ALGERIA
ANGOLA
ANTIGUA AND BARBUDA
ARGENTINA
ARUBA
AUSTRALIA
AUSTRIA
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BOLIVIA
BOSNIA-HERCEGOVINA
BOTSWANA
BRAZIL
BRITISH VIRGIN ISLANDS
BULGARIA
BURKINA FASO
BURMA (MYANMAR)
BURUNDI
CAMEROON
CANADA
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
COLOMBIA
CONGO (Brazzaville)
CONGO (Kinshasa)
COSTA RICA
COTE D IVOIRE
CROATIA
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
ECUADOR
EGYPT
EL SALVADOR
ESTONIA
FALKLAND ISLANDS
FEDERAL REPUBLIC OF GERMANY
FIJI
FINLAND
FRANCE
GABON
GAMBIA
GEORGIA
GHANA
GREECE
GRENADA
GUATEMALA
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN
IRELAND
ISRAEL
ITALY
JAMAICA
JAPAN
JORDAN
KAZAKHSTAN
KENYA
KIRIBATI
KOREA
KUWAIT
KYRGYZSTAN
LATVIA
LESOTHO
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAO
MACEDONIA (SKOPJE)
MADAGASCAR
MALAWI
MALAYSIA
MALI
MALTA
MAURITANIA
MAURITIUS
MEXICO
MOLDOVA
MONACO
MONGOLIA
MONTSERRAT
MOROCCO
MOZAMBIQUE
NAMIBIA
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NIGER
NIGERIA
NORFOLK ISLAND
NORWAY
OMAN
PAKISTAN
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
POLAND
PORTUGAL
ROMANIA
RUSSIA
RWANDA
SAN MARINO
SAO TOME AND PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA AND MONTENEGRO
SIERRA LEONE
SINGAPORE
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOUTH AFRICA
SPAIN
SRI LANKA
Steel Only
ST. KITTS AND NEVIS
ST. LUCIA
ST. VINCENT AND THE GRENADINES
SURINAME
SWAZILAND
SWEDEN
SWITZERLAND
SYRIA
TAIWAN
TANZANIA
THAILAND
TOGO
TOKELAU
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES
URUGUAY
VENEZUELA
VIETNAM
ZAMBIA
---- Please select from list ----
AL, Birmingham
AL, Huntsville
AL, Mobile
AK, Alcan
AK, Anchorage
AK, Anchorage, Fedex Facility
AK, Anchorage, St. Paul Airport
AK, Anchorage, UPS
AK, Dalton Cache
AK, Fairbanks
AK, Juneau
AK, Ketchikan
AK, Kodiak
AK, Pelican
AK, Petersburg
AK, Sand Point
AK, Sitka
AK, Skagway
AK, Valdez
AK, Wrangell
AZ, Douglas
AZ, Lukeville
AZ, Naco
AZ, Nogales
AZ, Phoenix
AZ, San Luis
AZ, Sasabe
AZ, Tucson
AR, Blythville, Arkansas Aesoplex
AR, Little Rock-N.L.R.
CA, Air Cargo Handling Services
CA, Alameda
CA, Andrade
CA, Burlingame, IBC Pacific
CA, Calexico
CA, Calexico-East
CA, Capitan
CA, Carquinez Strait
CA, Crockett
CA, DHL Worldwide Express
CA, DHL, Los Angeles
CA, El Segundo
CA, Eureka
CA, Fresno
CA, IBC Pacific
CA, Long Beach
CA, Los Angeles
CA, L.A. Int. Airport
CA, Martinez
CA, Monterey
CA, Morro
CA, Oakland
CA, Oakland, FedEx Courier Facility
CA, Ontario International Airport
CA, Ontario, UPS
CA, Otay Mesa Station
CA, Palm Springs Regional Airport
CA, Port Hueneme
CA, Port San Luis
CA, Redwood City
CA, Richmond
CA, Sacramento
CA, San Bernadino International Airport
CA, San Diego
CA, San Francisco
CA, San Joaquin River
CA, San Jose International Airport
CA, San Pablo Bay
CA, San Ysidro
CA, Selby
CA, Southern California Logistics Airport
CA, Stockton
CA, Suisun Bay
CA, S.F. Int. Airport
CA, Tecate
CA, Tnt Express Worldwide La
CA, Tnt Skypak
CA, Ventura
CO, Centennial Airport
CO, Denver
CT, Bridgeport
CT, Hartford
CT, New Haven
CT, New London
DE, Wilmington
DC, Washington
FL, Boca Grande
FL, Daytona Beach Airport
FL, Dhl, Miami
FL, Fernandina
FL, Fort Myers Airport
FL, Fort Pierce
FL, Ft. Lauderdale
FL, Jacksonville
FL, Key West
FL, Melbourne Regional Airport
FL, Miami
FL, Miami Int. Airport
FL, Ocala Regional Airport
FL, Orlando
FL, Orlando-Sanford Airport
FL, Panama City
FL, Pensacola
FL, Port Canaveral
FL, Port Manatee
FL, Pt. Everglades
FL, Sarasota-Bradenton Airport
FL, St. Petersburg
FL, Tampa
FL, West Palm Beach
GA, Atlanta
GA, Brunswick
GA, Savannah
HI, Hilo
HI, Honolulu
HI, Honolulu Int. Airport
HI, Kahului
HI, Kona
HI, Nawiliwilt-Pt Allen
ID, Boise
ID, Eastport
ID, Porthill
IL, Chicago
IL, Chicago, Nippon Courier Hub
IL, Decatur, Decatur User Fee Airport
IL, Dupage Airport
IL, Greater Rockford Airport
IL, Peoria
IL, Rockfort, Port Of Rockfort
IL, Waukegan Airport, Chicago
IL, Wheeling, Pal-Waukee Airport
IN, East Chicago
IN, Fort Wayne Airport
IN, Gary
IN, Hulman Regional Airport
IN, Indianapolis
IN, Indianapolis, Fedex Hub Facility
IA, Davenport
IA, Des Moines
KS, Wichita
KY, Lexington, Bluegrass Airport
KY, Louisville
KY, Louisville, UPS
KY, Owensboro-Evansville
LA, Avondale
LA, Baton Rouge
LA, Destrehan
LA, Good Hope
LA, Gramercy
LA, Lake Charles
LA, Morgan City
LA, New Orleans
LA, Port Sulphur
LA, Shreveport-Bossier Cty
LA, St. Rose
ME, Bangor
ME, Bar Harbor
ME, Bath
ME, Belfast
ME, Bridgewater
ME, Calais
ME, Eastport
ME, Fort Fairfield
ME, Fort Kent
ME, Houlton
ME, Jackman
ME, Jonesport
ME, Limestone
ME, Madawaska
ME, Portland
ME, Rockland
ME, Searsport
ME, Van Buren
ME, Vanceboro
MD, Annapolis
MD, Baltimore
MD, Baltimore-Washington International
MD, Cambridge
MD, Crisfield
MA, Boston
MA, Fall River
MA, Gloucester
MA, Lawrence
MA, Logan Airport-Boston
MA, New Bedford
MA, Plymouth
MA, Provincetown
MA, Salem
MA, Springfield
MA, Worcester
MI, Algonac
MI, Alpena
MI, Battle Creek
MI, Detour City
MI, Detroit
MI, Escanaba
MI, Ferrysburg
MI, Grand Haven
MI, Grand Rapids
MI, Mackinac Island
MI, Marquette
MI, Muskegon
MI, Oakland-Pontiac Airport
MI, Port Huron
MI, Presque Isle
MI, Rogers City
MI, Saginaw-Bay City
MI, Sault Ste. Marie
MI, Willow Run Airport
MN, Baudette
MN, Duluth
MN, Grand Portage
MN, Int. Falls-Ranier
MN, Minneap.-St. Paul
MN, Noyes
MN, Pinecreek
MN, Rochester
MN, Roseau
MN, Silver Bay
MN, Warroad
MS, Greenville
MS, Gulfport
MS, Pascagoula
MS, Vicksburg
MO, Kansas City
MO, Spirit of St. Louis Airport
MO, Springfield
MO, St. Joseph
MO, St. Louis
MT, Butte
MT, Del Bonita
MT, Great Falls
MT, Kalispell
MT, Morgan
MT, Opheim
MT, Piegan
MT, Raymond
MT, Roosville
MT, Scobey
MT, Sweetgrass
MT, Turner
MT, Whitetail
MT, Whitlash
MT, Wildhorse
NE, Omaha
NV, Las Vegas
NV, Reno
NH, Lebanon Municipal Airport
NH, Manchester User Fee Airport
NH, Portsmouth
NJ, Atlantic City
NJ, Camden
NJ, Gloucester City
NJ, Morristown Airport, Newark
NJ, Newark
NJ, Newark, Newark Fedex Eccf
NJ, Newark, UPS
NJ, Paulsboro
NJ, Perth Amboy
NJ, Trenton/Mercer Airport
NM, Albuquerque
NM, Columbus
NM, Santa Teresa
NM, Santa Teresa Airport
NY, Albany
NY, Alexandria Bay
NY, Binghamton Regional Airport
NY, Buffalo-Niagara Falls
NY, Buffalo TNT Skypak
NY, Cape Vincent
NY, Champlain-Rouses Pt.
NY, Clayton
NY, DHL, Jamaica
NY, Fort Covington
NY, Jamaica, Federal Express
NY, J.F.K. Int. Airport
NY, Massena
NY, New York
NY, New York JFK TNT Skypak
NY, Nyacc, Jamaica
NY, Ogdensburg
NY, Oswego
NY, Rochester
NY, Sodus Point
NY, Syracuse
NY, Trout River
NY, Uttica
NC, Charlotte
NC, Durham
NC, Morehead-Beaufort
NC, Reidsville
NC, Wilmington
NC, Winston-Salem
ND, Ambrose
ND, Antler
ND, Carbury
ND, Crane Lake
ND, Dunseith
ND, Fortuna
ND, Grand Forks
ND, Hannah
ND, Hansboro
ND, Hector International Airport
ND, Lancaster
ND, Maida
ND, Neche
ND, Noonan
ND, Northgate
ND, Pembina
ND, Portal
ND, Sarles
ND, Sherwood
ND, St. John
ND, Walhalla
ND, Westhope
OH, Akron
OH, Ashtabula
OH, Ashtabula/Conneaut
OH, Burlington Ait Express
OH, Cincinnati-Lawrenceburg
OH, Cleveland
OH, Columbus
OH, Conneaut
OH, Dayton
OH, Dayton, Emery Worldwide
OH, Dhl, Cincinnati
OH, Fairport
OH, Huron
OH, Lorain
OH, Rickenbacker Airport
OH, Toledo-Sandusky
OH, Wilmington
OK, Oklahoma City
OK, Tulsa
OR, Astoria
OR, Columbia-Snake River
OR, Coos Bay
OR, Kingsley Field Klamath Falls
OR, Medford-Jackson County Airport
OR, Newport
OR, Portland
OR, Portland International Airport
OR, Rogue Valley-Medford
PA, Allentown-Bethlehem
PA, Chester
PA, Erie
PA, Harrisburg
PA, Lehigh Valley
PA, Philadelphia
PA, Philadelphia Int'l Airport
PA, Pittsburgh
PA, UPS Courier Hub Facility
PA, Wlks-Barre/Scranton
PR, Aguadilla
PR, Fajardo
PR, Guanica
PR, Guayanilla
PR, Humacao
PR, Jobos
PR, Mayagues
PR, Ponce
PR, San Juan
PR, San Juan Int. Airport
RI, Mellville
RI, Newport
RI, Providence
SC, Charleston
SC, Columbia
SC, Georgetown
SC, Greenville-Sptburg
SC, Myrtle Beach International Airport
SD, Sioux Falls
TN, Bountville, Tri-City User Fee Airport
TN, Chattanooga
TN, Knoxville
TN, Memphis
TN, Nashville
TX, Addison User Fee Airport
TX, Amarillo
TX, Austin
TX, Beaumont
TX, Brownsville-Cameron
TX, Corpus Christi
TX, Dallas-Fort Worth
TX, Del Rio
TX, Eagle Pass
TX, Edinburg Airport
TX, El Paso
TX, Fabens
TX, Fort Worth Alliance Airport
TX, Freeport
TX, Galveston
TX, Hildago
TX, Houston
TX, Houston Intercontinental Airport
TX, Laredo
TX, Lubbock
TX, Orange
TX, Port Arthur
TX, Port Lavaca
TX, Presidio
TX, Progresso
TX, Rio Grande City
TX, Roma
TX, Sabine
TX, San Antonio
TX, Texas City
UT, Salt Lake City
VT, Beecher Falls
VT, Burlington
VT, Derby Line
VT, Highgate Springs-Alburg
VT, Norton
VT, Richford
VT, St. Albans
VI, Charlotte Amalie
VI, Christiansted
VI, Coral Bay
VI, Cruz Bay
VI, Frederiksted
VA, Alexandria
VA, Dublin, New River Valley Airport
VA, Front Royal
VA, Hopewell
VA, Newport News
VA, Norfolk
VA, Richmond-Petersburg
WA, Aberdeen-Hoquiam
WA, Anacortes
WA, Bellingham
WA, Blaine
WA, Boundary
WA, Danville
WA, Everett
WA, Ferry
WA, Friday Harbor
WA, Frontier
WA, Kalama
WA, Kenmore Air Harbor
WA, Laurier
WA, Longview
WA, Lynden
WA, Metaline Falls
WA, Neah Bay
WA, Nighthawk
WA, Olympia
WA, Oroville
WA, Point Roberts
WA, Port Angeles
WA, Port Townsend
WA, Seattle
WA, Seattle-Tacoma Int. Airport
WA, Seattle, Airborne Express
WA, Seattle, UPS Courier Hub
WA, Spokane
WA, Sumas
WA, Tacoma
WA, Vancouver
WA, Yakima Air Terminal
WV, Charlestown
WI, Ashland
WI, Green Bay
WI, Manitowoc
WI, Marinette
WI, Milwaukee
WI, Racine
WI, Sheboygan
WI, Superior
WY, Natrona County Intl. Airport
Expected Date of Importation (mm/dd/yyyy):
Expected Date of Export (mm/dd/yyyy):
Customs Entry Number (Optional):
Date License Valid From:
Date License Valid Through:
Date of Application:
Subregion Information
Subregion of Final Destination:
-Select a Subregion-
Alabama/Mississippi
Arizona
California
Florida
New Mexico/El Paso
New Orleans
Texas
Rest of the United States
Customer Affiliation:
Affiliated
Unaffiliated
Foreign Trade Zone
Final Customer Unknown
Name:
Address 1:
Address 2:
County:
City:
State:
<select state here>
Aguascalientes
Alabama
Alaska
Alberta
Arizona
Arkansas
Baja California
Baja California Sur
British Columbia
California
Campeche
Chiapas
Chihuahua
Coahuila
Colima
Colorado
Connecticut
Delaware
District of Columbia
Distrito Federal
Durango
Florida
Georgia
Guanajuato
Guerrero
Hawaii
Hidalgo
Idaho
Illinois
Indiana
Iowa
Jalisco
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
México
Michigan
Michoacán
Minnesota
Mississippi
Missouri
Montana
Morelos
Nayarit
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland
North Carolina
North Dakota
Northern Territories
Nova Scotia
Nuevo León
Oaxaca
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puebla
Quebec
Querétaro
Quintana Roo
Rhode Island
San Luis Potosí
Saskatchewan
Sinaloa
Sonora
South Carolina
South Dakota
Tabasco
Tamaulipas
Tennessee
Texas
Tlaxcala
Utah
Veracruz
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yucatán
Yukon
Zacatecas
Other
Zip:
Product 1
HTSUS Number 1:
---- Please select from list ----
2523.10
2523.29
2523.90
Product Description:
Quantity
:
Unit:
Entered Value in US (ie 50000.00):
Note: Do not use commas or $
Unit Value:
Mexican Export License #:
kg
mt
$
Is this entry made pursuant to the disaster relief provisions of the Agreement?
Yes
No
Product 2
HTSUS Number 2:
---- Please select from list ----
2523.10
2523.29
2523.90
Product Description:
Quantity
:
Unit:
Entered Value in US $:
Unit Value:
Mexican Export License #:
kg
mt
Is this entry made pursuant to the disaster relief provisions of the Agreement?
Yes
No
Product 3
HTSUS Number 3:
---- Please select from list ----
2523.10
2523.29
2523.90
Product Description:
Quantity
:
Unit:
Entered Value in US $:
Unit Value:
Mexican Export License #:
kg
mt
Is this entry made pursuant to the disaster relief provisions of the Agreement?
Yes
No
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