NON-COMMERCIAL INVOICE

SHIPPER INVOICE NO. AND DATE

Company Name:
P/O NO. AND DATE

Zip :
Phone : Attention.
CONSIGNEE BUYER (IF OTHER THAN CONSIGNEE)

Attention.
NOTIFY OTHER REFERENCES
Ticket number: .
The scanner serial number that was used with the defective accessory: .

DEPARTURE DATE

VESSEL/FLIGHT FROM TERMS OF DELIVERY AND PAYMENT

City/Country This shipment is non-commercial value due to in-warranty.
TO

SHIPPING MARKS NO. & KIND OF PKGS:GOODS DESCRIPTION QUANTITY UNIT PRICE
(EA) (U$)
1. Product: , Type: . 1 100.00

TOTAL 1 box
This amount for custom purpose only

<NOTE>

SIGNED BY

Attention / Dealer's company name

at was used with the defective accessory: .

rcial value due to in-warranty.

AMOUNT
(U$)
100.00

100.00
This amount for custom purpose only

s company name