Export/Import Assistance
Certificate of Origin Order Form

The undersigned/purchaser acknowledges and agrees that transmission of this completed form to the America - Israel Chamber of Commerce Chicago (AICC) by any medium, including electronic mail, facsimile or via AICC’s website, creates a binding legal obligation upon the undersigned to pay for the Certificates of Origin so ordered. The undersigned/purchaser hereby specifically waives any claims or defenses that it is not obliged to pay because of the medium chosen for order transmission, e.g., because AICC does not possess an order form containing its original handwritten signature.

General Information:
* Name:
  Title:
* Company Name:
* Address:
* City:
* State:
* Zip:
* Phone:
  Fax:
* Email:
Please check here if you do not wish to receive email about the chamber.
Bussiness Sectors:
Please indicate your company's business sector by checking the appropriate box below
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  Accounting    Accounting;Consulting    Acounting 
  Advertising    Agribusiness    Banking 
  Construction    Consulting    Distribution 
  Economic Development    Education    Executive Recruiting 
  Executive Recruiting/Human Res    Exeutive Recruiting/H.R.    Financial 
  Financial Services    Flowers    Food & Beverage 
  Funeral Services    H.R.    Health and Beauty 
  Health Care    Import/Export    Insurance 
  International Relations    Investment Banking    Law 
  Manufacturing    Marketing    Media 
  Not-for-Profit    Other    Packaging 
  Pharmaceuticals    Private Banking    Private Equity 
  Public Relations    Publishing    Real Estate 
  Security    Security, Technology    Shipping 
  Sports & Fitness    Technology    Technology Incubator 
  Telecom    Telecommunications    Translation 
  Transportation    US-Israel Business Development    Venture Capital 
  Wholesale Distribution 
Export Information:
  Approximate value
of export ($U.S.):
  Referred By:
if "Other" please indicate below
  Other Referrer:
Your Order:
QTY Description
Single @ $25 each
Book(s) of 10 @ $150
Payment Information
Amount to Charge:
Credit Card Type:
* Card Number:
* Security Code:
* Expiration Date: MM/YY
Shipping Method

Certificates of Origin are shipped by U.S. Mail. If you would like us to ship them express, please choose a carrier below and enter your account number.

Express Carrier:
Account Number:
 
Disclaimer    Copyright 2006, AICC