Form BLS-3007D Export Item Price Survey

U.S. Department of Labor
International Price Program

This form contains information that you previously provided to the U.S. Department of Labor.

Please update this information and return via fax to (877)237-8070 (Toll Free) or (202)691-7272
or, if necessary, mail to U.S. DOL, Bureau of Labor Statistics, Code 5, Washington, DC 20212.

Export Item Price Survey

If you have any questions, contact: JOE ANALYST
(202) 555-1212
analyst.joe@bls.gov

http://www.bls.gov/mxp/
200501 R123456B D123456B

1. If the item information in this section has changed, please UPDATE THE INFORMATION and FILL IN THE BOX...………..
WAVEBASHER 26IB MOTOR BOAT; LENGTH: 26'; BEAM: 8'6"; DRAFT: 3'6"; INBOARD ENGINE: 5.0 LITER; 350 HP;
MATERIAL OF CONSTRUCTION: FIBERGLASS; GROSS WEIGHT: 6200 LBS.

Exported under Schedule B Number: 8903920050

Exported to: FRANCE

Is this an Intracompany Transfer? YES

Priced per: EACH

What is the Class of Buyer?
PARENT COMPANY

Discounts/Surcharges:

Is Price Specific to Quantity Ordered? YES
5-10 BOATS

Last Price Received:

DECEMBER 2004

New Price Information for :

DISTRIBUTOR

200.0000 U.S. DOLLAR DEDUCTED

CASH

2.0000% NOT DEDUCTED

45,000.0000

FOB FACTORY

JANUARY 2005

2. If the price HAS CHANGED, please fill in the new price below.

,

U.S. DOLLAR

,

.

Currency:
Price Basis:

U.S. DOLLAR
FOB FACTORY

If possible, please provide the reason(s) for the price change:

3. If the price has NOT CHANGED from the last price received, please FILL IN THE BOX to the right………………………….….
4. If the item was NOT TRADED this month, please FILL IN THE BOX to the right……………………………………………….……
Also, if possible, please provide an ESTIMATED price in the boxes in #2.
5. If any physical characteristics of the item have been MODIFIED, please UPDATE THE INFORMATION in #1. Please
enter the change in the production cost associated with this modification. Do not simply enter the total change in price.
(+/-)

(Indicate amount and currency of the modification)

6. If the item has been DISCONTINUED or REPLACED, please FILL IN THE BOX to the right……………………………………..
Then call Joe Analyst
(202) 555-1212
Remarks:

FILL IN THIS BOX if the address or respondent information below has changed. Please make corrections in the Remarks section.
MS. MINNIE MOKE
PRICING MANAGER
WAVEBASHER BOATS INC.
20 BEACH DRIVE
SAN DIEGO CA 55555

OMB NUMBER 1220-0025

Phone: (691) 555-1000
Fax:I(691) 555-2000
E-mail: MOKE.MINNIE@WAVEBASHERBOATS.COM

3054

200501 R123456B D123456B

Page1 of 1

0443271427

U.S. Department of Labor
Bureau of Labor Statistics
International Price Program

Import/Export Item Price Survey

�
�

The Bureau of Labor Statistics, its employees, agents, and partner statistical agencies. will use the information you provide for statistical purposes only and will hold the information in confidence
to the full extent pe,mitted by law. In accordance with the Confidential Information Protection and Statistical Efficiency Act (44 U.S.C. 3572) and othe, applicable Federal laws, your responses will
not be disclosed in Identifiable form without your informed consent Paperwork R e duction Act Statement. Your voluntary cooperation is needed to make the results of this survey
comprehensive, accurate, and timely. We estimate that completing each form .....;11 take an average of 5 mfnutes (varying from 1 to 30 minutes). Th,s estimate takes into account time for
reviewing instructions, searching existing data sources, gathering and maintaining the necessary data, and completing and reviewing the information. If you have any comments regarding this
survey, including suggestions for reducing the burden, send them to the Bureau of Labor Statistics, Division of International Prices, 1220-0025, 2 Mass Ave NE, Washington, DC 20212.
PLEASE DO NOT RETURN YOUR FORMS TO THIS ADDRESS. The 0MB control number fo, this voluntary survey is 1220-0025. Without a currently valid number BLS 'WOUid not be able to
conduct this survey.

N
0
0

The attached survey asks you to report current price information for select items. This survey is designed to measure changes in
U.S. import and export prices. If you have any questions, please contact the analyst indicated at the top of the attached forms. For
further information on the International Price Program, visit our web site at http://www.bls.gov/mxp/. Thank you for your cooperation.
Please follow these instructions:

Please complete the attached survey and return via fax to (877) 237-8070 (toll free) or (202) 691-7272 as soon as
possible, preferably within one week.
Only use black or blue pen when completing these forms. Do not use pencil.
Please do not return this cover sheet.
Where requested, please fill in the box completely so the scanner can Identify any changes.

0

w

N

;;;;;;;�

(Jl
0)
N

1.

w

Please review the information on the form. Make corrections where necessary.
lntracompany Transfer:

.l>,
(Jl
0)
-..J
CX)
co
co
co
co

Is this a transaction between two related companies? (e.g., between subsidiary and parent company)

Class of Buyer/Seller: Please provide the Class of Buyer (Export Items) or Seller (Import Items) if the class affects the price.
Examples of Classes of Buyer/Seller include Parent Company, Affiliate, Subsidiary, Sister Company, Distributor, Dealer, End
User, etc. If the price does not vary with different buyers or sellers, please enter "Class does not affect the price."
Quantity Ordered: Does the price vary according to the Quantity Ordered? If so, please indicate a quantity for which you will
consistently provide price information.

(Export Items Only): Please provide price information for items exported to the specified destination only. If you
previously indicated that the price charged to buyers was the same regardless of destination, 'World' will appear as the
destination.
Exported to

� (Import Items Only): Please indicate any duty that is included in the price.
Please indicate discounts or surcharges (quantity discount, commission, fuel surcharge, etc.) and the
percentage or amount (and currency) of each. Specify whether you have already deducted the discount from the price you
provided or whether you already added the surcharge.

Discounts/Surcharges:

Last Price Received: If this information is incorrect according to your records, please correct it in the Remarks area. (EST
indicates that the previous price was estimated).

2.

Please provide price data.
Transaction prices are preferred. These are prices at which you actually bought the item (imports) or sold the item
(exports). Please provide the price for the transaction nearest the beginning of the month. If the price has changed from the Last
Price Received, please enter the new price in the boxes in #2.

Prices:

Price Bases: lncoterm examples include: EXW; FCA; FAS; FOB; CFR; CIF; CPT; CIP; OAF; DES; DEQ; DOU; DDP.
Please append the named place or port of shipment or of destination, as appropriate, to the item description.
For definitions, refer to http:/www.iccwbo.org/incoterms/.

3.

If there has been no change in the price, please fill in the box to the right of #3.

4.

If the item was not traded this month, please fill in the box to the right of #4. Even though the item was not traded, please
estimate in box #2 the price that would have been charged for an actual transaction.

5.

Please enter the change in production cost that resulted from a modification to the physical characteristics of the item. Please do
not simply enter the total change in price unless it is the same as the production cost.

6.

If the item has been discontinued, fill in the box in #6. Please call the analyst listed to provide more specific information
regarding the discontinuation. If the item was replaced, please enter the new item description under #1.

/

BLS-3007D
0MB No. 1220-0025
Expires Oct. 31, 2012