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DEPARTMENT OF HOMELAND SECURITY DOCUMENT/PAYMENT TRANSMITTAL

U.S. Customs and Border Protection (7501)


Entry Summary Number and/or Action Number Importer of Record Number

Entry Date
This form is in “Test” status for a specified time to
05/27/2009
collect comments for further action. It is for testing
Summary Date purposes only and not to be reproduced at this time.

The final product could have a 2D Barcode in this field


Team Number
for data collection.

COLLECTION INFORMATION (Complete only if payment attached)


Code Amount
(001) Duty
(499) MPF
(501) HMF
( )
( )
( )
( )
TOTAL
Comments:

CBP Form 7501 TEST (04/09)

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