This form contains 71 fields organized into 15 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Bill of Lading
Bill of Lading Number Text
Please enter the Bill of Lading number for the shipment.
Consignee Information
Consignee's Name Text
Please enter the full name of the consignee.
Consignee's Address Text
Please provide the complete mailing address of the consignee.
Container Numbers
See Attachment Checkbox
Check this box if the container numbers are provided in an attached document.
Container Number 1 Text
Please provide the first container number associated with the shipment. Fill only if 'See Attachment' is 'No'.
Depends on: See Attachment
Container Number 2 Text
Please provide the second container number associated with the shipment. Fill only if 'See Attachment' is 'No'.
Depends on: See Attachment
Description of Merchandise
Merchandise Description Text
Please provide a detailed description of the merchandise being declared.
Fifth Article Details
Fifth Article HTS Number Text
Provide the Harmonized Tariff Schedule number for the fifth article or component, without dashes or symbols.
Fifth Article Entered Value Number
Enter the customs value for the fifth article or component.
Fifth Article Name Text
Provide the common name or description of the fifth article or component.
Fifth Article Plant Scientific Genus Text
Enter the scientific genus name of the plant material for the fifth article.
Fifth Article Plant Scientific Species Text
Enter the scientific species name of the plant material for the fifth article.
Fifth Article Country of Harvest Text
Specify the country where the plant material for the fifth article was harvested.
Fifth Article Quantity of Plant Material Number
Provide the quantity of plant material for the fifth article.
Fifth Article Unit Text
Specify the unit of measure for the quantity of plant material for the fifth article.
Fifth Article Percent Recycled Number
Enter the percentage of recycled content in the fifth article.
First Article Details
HTS Number Text
Enter the Harmonized Tariff Schedule (HTS) number for the article, without any dashes or symbols.
Entered Value Number
Enter the declared value of the article.
Article/Component Text
Enter the specific name or description of the article or component.
Plant Scientific Name Genus Text
Enter the genus part of the plant's scientific name.
Plant Scientific Name Species Text
Enter the species part of the plant's scientific name.
Country of Harvest Text
Enter the country where the plant material was harvested.
Quantity of Plant Material Number
Enter the quantity of the plant material.
Unit Text
Enter the unit of measurement for the quantity of plant material (e.g., kg, lbs, pieces).
Percent Recycled Number
Enter the percentage of the article that is recycled.
Fourth Article Details
Fourth Article HTS Number Text
Enter the Harmonized Tariff Schedule (HTS) number for the fourth article or component, without dashes or symbols.
Fourth Article Entered Value Number
Provide the entered value for the fourth article or component.
Fourth Article/Component Description Text
Describe the fourth article or component.
Fourth Article Plant Scientific Genus Text
Enter the genus of the plant scientific name for the fourth article.
Fourth Article Plant Scientific Species Text
Enter the species of the plant scientific name for the fourth article.
Fourth Article Country of Harvest Text
Specify the country where the fourth article was harvested.
Fourth Article Quantity of Plant Material Number
Enter the quantity of plant material for the fourth article.
Fourth Article Unit of Measure Text
Provide the unit of measure for the quantity of plant material of the fourth article.
Fourth Article Percent Recycled Number
Enter the percentage of the fourth article that is recycled.
General
PREPARER’S SIGNATURE Signature
Importer Information
Importer's Name Text
Please enter the full name of the importer.
Importer's Address Text
Please provide the complete street address, city, state, and zip code of the importer.
Manufacturer Identification Code
Manufacturer Identification Code Text
Please enter the Manufacturer Identification Code (MID).
Preparer Information
Preparer's Name Text
Enter the full printed name of the person preparing this declaration.
Email Address Text
Enter the email address of the preparer.
Telephone Number Text
Enter the telephone number of the preparer.
Declaration Date Date
Enter the date this declaration is being completed.
Second Article Details
HTS Number (Second Article) Text
Enter the Harmonized Tariff Schedule (HTS) number for the second article or component, without any dashes or symbols.
Entered Value (Second Article) Number
Provide the customs entered value for the second article or component.
Article/Component (Second Article) Text
Specify the article or component being declared for the second entry.
Plant Scientific Name Genus (Second Article) Text
Enter the genus of the plant's scientific name for the second article or component.
Plant Scientific Name Species (Second Article) Text
Enter the species of the plant's scientific name for the second article or component.
Country of Harvest (Second Article) Text
Provide the country where the plant material for the second article or component was harvested.
Quantity of Plant Material (Second Article) Number
Enter the quantity of plant material for the second article or component.
Unit (Second Article) Text
Specify the unit of measure for the quantity of plant material for the second article or component.
Percent Recycled (Second Article) Number
Enter the percentage of recycled content in the second article or component.
Shipment Identification
Estimated Date of Arrival Date
Please provide the estimated date when the shipment is expected to arrive.
Entry Number Text
Please provide the unique identification number assigned to this entry.
Sixth Article Details
Sixth Article HTS Number Text
Enter the Harmonized Tariff Schedule (HTS) number for the sixth article, without dashes or symbols.
Sixth Article Entered Value Number
Provide the entered value for the sixth article.
Sixth Article Component Text
Specify the article or component of the sixth article.
Sixth Article Plant Genus Text
Enter the genus of the plant scientific name for the sixth article.
Sixth Article Plant Species Text
Enter the species of the plant scientific name for the sixth article.
Sixth Article Country of Harvest Text
Provide the country where the sixth article was harvested.
Sixth Article Quantity of Plant Material Number
Specify the quantity of plant material for the sixth article.
Sixth Article Unit Text
Enter the unit of measurement for the quantity of the sixth article's plant material.
Sixth Article Percent Recycled Number
State the percentage of the sixth article that is recycled.
Third Article Details
Third Article HTS Number Text
Please enter the Harmonized Tariff Schedule (HTS) number for the third article or component, ensuring no dashes or symbols are included.
Third Article Entered Value Number
Please enter the declared value for the third article or component.
Third Article Component Text
Please enter the specific article or component being declared for the third article.
Third Article Plant Scientific Genus Text
Please enter the scientific genus name for the plant material of the third article.
Third Article Plant Scientific Species Text
Please enter the scientific species name for the plant material of the third article.
Third Article Country of Harvest Text
Please enter the country where the plant material of the third article was harvested.
Third Article Quantity of Plant Material Number
Please enter the quantity of plant material for the third article.
Third Article Unit Text
Please enter the unit of measure for the quantity of plant material for the third article.
Third Article Percent Recycled Number
Please enter the percentage of recycled material for the third article.