Order Process

I certify that all the facts contained in this statement are true and correct to the best of my knowledge and I do not know of any additional facts which are inconsistent with the above statement. I shall promptly notify the Exporter, disclosing any change of facts or intentions set forth in this statement which occurs after statement has been prepared and forwarded. I certify that I will not re-export, resell, or otherwise dispose of any items approved on this transaction to any parties not identified on this form. I certify that our company terms and conditions language does not discriminate against another person based on race, religion, sex, national origin or nationality in accordance with U.S. Antiboycott Regulations. I understand that failure to complete this form fully and accurately may result in my purchase order being delayed or rejected.

Purchaser of Record

Ultimate Consignee

Intermediate Consignee

Other Parties in Transaction

Part and/or Technical data

Intended End Use (select any that apply)

Special Notice to Purchasers

Section 1: Special Notice to Purchasers

Section 2: General Access Information

Section 3: Third Party Primary Contact Information

Section 4: Third Party Company Information

Section 5: Parent Company Information

Section 6: Company Information Verification and Acknowledgement

Section 7: Individual Company User Information