SHOPKO STORES INC. & PAMIDA STORESIMPORT CALCULATION SHEET

To be completed by agent/manufacturer (See following page for instructions)

1 Date: 11 Country of Exportation

12 Country of Origin2 Manufacturer

13 Earliest Available Date3 Agent:

14 Inspection Certificate Signed By4 US Contact

15 Is Visa Required?5 Phone #

Quota #6 Fax #

16 Is Merchandise Eligible for GSP?Email Address

17 Is Trademark Release Letter Required?7 Style/Manufacturer #

18 Does LC Need to be Transferable?Current Shopko Sku # (Or New)

8 Description of Item (PROVIDE MATERIAL & VALUE BREAKDOWN ON PG 2) 19 3rd Party/Shipper Documents Permitted?

20 Is Price Subject to Rate Fluctuations?

21 Quote Base on Currency Rate of US $1.00 =

9 Beneficiary to be Listed on L/C 22 UPC with Check Digit

Description

Product Color

Product Size

UPC Manufacturer ID

Primary UPC (Yes or No)

Additional UPC #'s10 Foreign Bank to be Listed on L/C

CARTON INFORMATION

23 Master Carton Pack 28 Carton Dimensions

(Yes or No)24 Shippable Inners

Master25 Inner Pack

Inner26 Master Pack Cube

Eaches27 Master Pack Weight

PRODUCT COST INFORMATION (HONG KONG OR OTHER SOUTH SEA PORT)

HONG KONG OR OTHER SOUTH SEA PORT

29 FOB Cost - Port of $US$29 FOB Cost - Port of $US$

30 Buying Commission30 Buying Commission

31 Duty on FOB Cost: HTS# (BELOW) 31 Duty on FOB Cost: HTS# (Below)

$ $

32 Ocean Freight CFT $32 Ocean Freight CFT $

33 Handling Charge (% FOB Price) 33 Handling Charge (% FOB Price)$ $

34 Inland Freight Rate to Shopko 34 Inland Freight Rate to Shopko

Distribution Centers $/CFT $Distribution Centers $/CFT $

35 Miscellaneous Fees $35 Miscellaneous Fees $

36 Total Estimated Landed Cost36 Total Estimated Landed Cost

38 Full Container Quantity (in units) 20FT/40FT37 Factory Location

$

Length VVidth Height

SHOPKO STORES INC. & PAMIDA STORES

IMPORT CALCULATION SHEET

PAGE 2

1 Date:

2 Manufacturer

3 Shopko Sku #

4 Style/Manufacturer #

5 Material Breakdown of each Component:

6 Value Breakdown of each Component:

ALTERNATIVE INFORMATION / DOMESTIC INFORMATION

4. Payment Terms1. Alternative Vendor Name:

2. Alternative Cost: $ 5. FOB Point / Freight Terms:

THIS IS A REQUIREMENT FOR EVERY QUOTEINSERT COLORED PICTURE

3. ADJUSTED DOMESTIC COST: 6. ADJUSTED ELC COST: $