Export End Use Declaration Form

End-Use Declaration

This form must be completed IN FULL by an authorized person before your parts can be released. Material sold by Aircraft Component Design, Inc. is intended for use in civil applications only. They are strictly prohibited to be shipped to any country that has an embargo placed on it by the United States Government. In certain instances an export license might be required, even for commercial end-use items. All Classified and controlled by the International Emergency Economic Powers Act (IEEPA), corresponding Export Administration Regulation (EAR), the Arms Export Control Act (AECA) and corresponding International Traffic in Arms Regulation (ITAR) require an export license. Obtaining a necessary Export License, if needed, and all associated costs are the customer's responsibility. All international customers are required to provide the following information:

Your PO# *

Part Application *

Other (Specify)

Next Higher Assy P/N *

Nomenclature *

Specific Aircraft Model *

Specific Engine Model *

Final End User Category *

Final End User Name *

Final End User Address *

Country

Address 1 *

Address 2

City *

State *

ZIP code *

Can you provide a copy of a valid export license? *

Yes

N/A

Will the part be re-exported or trans-shipped to another country? *

Yes

If yes, where?

Has your Company now or ever been debarred (banned) for Arm Export Control Act Violation(s) by the U.S. Governments Directorate of Defense Trade Controls? *

Yes

Has your company Owners, Officers or Agents now or ever been debarred (banned) for Arm Export Control Act Violation(s) by the U.S. Governments Directorate of Defense Trade Controls? *

Yes

Has your company , its owners, officers or agents name now or ever appeared on any US Government Agency denied persons or entity list? *

Yes

By submitting this form, you accept the Mollom privacy policy.