Form 3461 Entry and Immediate Delivery

DEPARTMENT OF HOMELAND SECURITY U.S.

OMB No. 1651-0024
Exp. 04-30-2013

Customs and Border Protection

ENTRY/IMMEDIATE DELIVERY
19 CFR 142.3, 142.16, 142.22, 142.24

1. ARRIVAL DATE

2. ELECTED ENTRY DATE 3. ENTRY TYPE CODE/NAME

5. PORT

6. SINGLE TRANS. BOND

7. BROKER/IMPORTER FILE NUMBER

8. CONSIGNEE NUMBER
10. ULTIMATE CONSIGNEE NAME

12. CARRIER CODE

4. ENTRY NUMBER

9. IMPORTER NUMBER
11. IMPORTER OF RECORD NAME

13. VOYAGE/FLIGHT/TRIP 14. LOCATION OF GOODS-CODE(S)/NAME(S)

15. VESSEL CODE/NAME
16. U.S. PORT OF UNLADING

17. MANIFEST NUMBER

18. G.O. NUMBER

19. TOTAL VALUE

20. DESCRIPTION OF MERCHANDISE
21. IT/BL/AWB
CODE

22. IT/BL/AWB NO.

23. MANIFEST QUANTITY

27. CERTIFICATION

I hereby make application for entry/immediate delivery. I certify that the above
information is accurate, the bond is sufficient, valid, and current, and that all
requirements of 19 CFR Part 142 have been met.
SIGNATURE OF APPLICANT

PHONE NO.

DATE
29. BROKER OR OTHER GOVT. AGENCY USE

24. H.S. NUMBER

25. COUNTRY
OF ORIGIN

26. MANUFACTURER NO.

28. CBP USE ONLY
OTHER AGENCY ACTION REQUIRED, NAMELY:

CBP EXAMINATION REQUIRED.
ENTRY REJECTED, BECAUSE:

SIGNATURE
DELIVERY
AUTHORIZED:

DATE

Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond
to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is
1651-0024. The estimated average time to complete this application is 15 minutes. If you have any comments regarding the burden estimate
you can write to U.S. Customs and Border Protection, Office of Regulations and Rulings, 799 9th Street, NW., Washington DC 20229.

CBP Form 3461 (10/09)