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
  Accountin    Accounting    Acounting 
  Agribusiness    Banking    Construction 
  Consulting    Distribution    Economic Development 
  Education    Energy    Executive Recruiting 
  Executive Recruiting/Human Res    Exeutive Recruiting/H.R.    Financial 
  Financial Services    Financial Services; Wealth Mgm    Flowers 
  Food & Beverage    Funeral Services    H.R. 
  Health and Beauty    Import/Export    Information Technology 
  Insurance    International Relations    Investment Banking 
  Jewelry    Law    Life Sciences 
  Management Services    Manufacturing    Marketing 
  Media    Not-For-Profit    Other 
  Packaging    Pharmaceuticals    Private Banking 
  Private Equity    Public Relations    Real Estate 
  Security    Shipping    Sports & Fitness 
  Technology    Telecommunications    Translation 
  Transportation    US-Israel Business Development    Venture Capital 
  Wealth Management    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:
 
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