Certificate of Free Sale Application

Company Name*

Company Address*

Street Address Address Line 2 City State ZIP Code

State of Incorporation*

State

The undersigned does hereby declare that the goods described herein are manufactured in and are products of the United States of America. The undersigned does also hereby declare that the goods described herein are freely sold in the United States of America and the goods described herein are not regulated by the EPA, FDA or the U.S. Department of Agriculture.*

I do declare the above statements are correct.
I am not the manufacturer and I will submit a signed declaration(s) from the manufacturer(s) stating that the products are manufactured in the USA.

Contact's Name*

First Last

Title*

Email*

Phone*

Number of Countries Requested*

Please note that fees are per individual certificate per country (meaning, only one country can be listed on a certificate).

Country/Countries Requested*

Fees are per individual certificate, per country. DO NOT use a regional name, like "European Union". If for some reason a country does not accept our Certificate of Free Sale, we will refund your money in full. Please note that all Certificates are good for one year from date authorized.

Number of Products for Certificate(s)*

The base certificate fee covers up to 10 products. If you would like more than 10 products listed on a certificate, an additional cost will be charged for each additional 10 products.

Product Names (as they appear on the shipping documents for which the certificate will be used):*

Please copy in product names, with one product on each line.

Required Documentation: Please upload copies of two (2) invoices showing the sale of each product to two (2) different U.S. customers. The invoices must be dated within the last 12 months.*

Drop files here or

Optional Documentation: If you are not the manufacturer of the above products, we will need a written declaration from the manufacturer. If there is more than one manufacturer, we will need a declaration from each manufacturer and please specify which products on your certificate are related to which manufacturer.

Drop files here or

Would you like an Apostille from the Commonwealth of Pennsylvania? ($20 additional cost per copy)*

Yes
No

An Apostille is required for 113 countries who are members of the Hague Convention. View the entire list here: http://www.internationalapostille.com/hague-apostille-member-countries/

How many Apostilles do you require?*

We request that the completed Certificate(s) be returned via:*

Account Number

Account Number - Special Shipping Requests

Please send the completed Certificate(s) to ATTN:*

First Last

Address (if different from above)

Street Address Address Line 2 City State ZIP Code

Comment Box: Do you have any questions, comments, or concerns?

Base Cost: Certificate of Free Sale*

One Certificate with up to 10 products.

Extra Cost: 2 Certificates

Price: $25.00

Extra Cost: Three Certificates

Price: $25.00

Extra Cost: Four Certificates

Price: $25.00

Extra Cost: Five Certificates

Price: $25.00

Extra Cost: Up to 20 Products Listed on Certificate(s)

Price: $25.00

Extra Cost: Up to 30 Products Listed on Certificate(s)

Price: $50.00

Extra Cost: Up to 40 Products Listed on Certificate(s)

Price: $75.00

Extra Cost: Up to 50 Products Listed on Certificate(s)

Price: $100.00

Extra Cost: 1 Apostille

Price: $20.00

Extra Cost: 2 Apostilles

Price: $40.00

Extra Cost: 3 Apostilles

Price: $60.00

Extra Cost: 4 Apostilles

Price: $80.00

Extra Cost: 5 Apostilles

Price: $100.00

Extra Cost: Certified US Mail

Price: $10.00

Total Cost

$0.00

Payment Options*

You will be redirected to PayPal for checkout upon form submission.

Please send your check to World Trade Center Harrisburg, 600 N Hartley Street, Suite 110, York, PA 17404.

Application Agreement*

I hereby verify that all information provided is accurate to the best of my knowledge. I also understand that the Certificate of Free Sale is good for one year from the authorized date.

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