APPLICATION TO DISTRICT DIRECTOR U.S. CUSTOMS SERVICE
TO FILE C.F. 301 - CONTINUOUS

1. Importer Name   
2.  Importer I.D.  
3. Street
4. City 5. State  6. Zip

7. Describe Merchandise (Use additional pages if necessary)                              8.
1. Country of Origin
2  Country of Origin
3. Country of Origin
4. Country of Origin
5. Country of Origin
6. Country of Origin

                            Last Twelve Months                                             Estimate Next Twelve Months

                            Value                  Est. Duty             No. Entries     Value                  Est. Duty               No. Entries
9. Total Imported:                      

Activity    Activity Name and Customs Regulations
 Code                 in which conditions codified.
   Importer or Broker ............. 113.62

10. Bond Amount Requested          Bond amount approved ____________

This bond will be filed in the U. S. Customs District of Los Angeles, CA.

11. Years in Business

12. Type of Business  Sole Proprietorship Partnership Corporation Individual

CERTIFICATION

I certify that the factual information contained in this application is true and accurate and any
information provided which is based upon estimates is based upon the best information available
on the date of this application.

13. By:     14.  Title    15.  Date


16. Signature: X _________________________________________