Equilibar must obtain a certification from its customers that they will not ship products to certain individuals, foreign nationals or to companies who do business with these individuals. These individuals or companies are classified as “denied parties” or “restricted parties” by the U.S. government. Equilibar is required by federal law to collect and maintain the information requested below, and Equilibar will use such information solely to ensure compliance with applicable export laws, rules, and regulations. All information will be kept strictly confidential except where required by US law. If you have further questions regarding this law, please contact me at 828-650-6590 or at email@example.com or go to www.bis.doc.gov for further information.
Equilibar ensures that all shipments are done in accordance with Export Administration Regulations (EAR) and any diversion contrary to U.S. Law is prohibited. To maintain this compliance, we must have the following on file for every order for each application. If your order is for the same application, please contact the Sales Department and request a blanket export compliance form. ** ALL LINES MUST BE FULLY ANSWERED IN ORDER FOR EQUILIBAR TO SHIP YOUR ORDER ** ORDER INFORMATION USER INFORMATION Address Where Product Will Be Used End Use Information Will this be re-exported in the form it is received? (Required) YES NO Will the items in this shipment be used in any non-commercial application (e.g. military or nuclear)? (Required) YES NO
If the above information were to change, for example, items will be re-exported to a different End User or used for a different application, you agree to provide Equilibar written notification of the changes and a new end user / end use form.
You are required to comply with the Equilibar, LLC. Standard Terms and Conditions of Quotation and Sale, including but not limited to, the requirement to comply with all applicable U.S. import, export control and sanctions laws, regulations, orders and requirements. By electronically signing, you certify that you have reviewed, understand and agree to abide by these terms and conditions that apply to quotations and sales. By electronically signing, you also certify that, to the best of your knowledge, the information provided is accurate and complete.
Sign and Consent Click to Consent (Required) By clicking this box I confirm that all data entered on this form is accurate and correct to the best of my understanding. I will immediately notify Equilibar with any changes as soon as I become aware of them. Your Email Address (Required) Your Signature (Required)
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