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Count No. FOR: 2) USPPI EIN or SSN: EEI FILING 3) Company/Individual's Name: 4) Contact Name: 5) Street Address: 6) City, ST ZIP Code: 7) Phone: 8) Fax: 9) Email address* : *If available - ITN request can be automatically returned to your email Ultimate Consignee 17) License Required? Y/N 10) Name: 11) Company/Individual's Name: 12) Contact Name: 18) Export License or License Exception Symbol 13) Street Address: 14) City, State/Province, Postal code 15) Country of Destination 16) Phone:.

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