Export Compliance Statement

The United States Department of Commerce Bureau requires all US exporters to keep records of where and for what our product’s end use will be. To help us comply with this US law, we would kindly ask you to please fill out the export compliance statement for your purchase order. By clicking submit, you are consenting for us to use your data to process your order. For more information you may view our Privacy Policy.

( for the location where the tester will be used )

Export Compliance Statement

Which Ikonix USA division's products are you purchasing?

Are you a reseller?

Yes

Is this a new or existing customer?

New

Existing

End User Country

End User Company Name:

End User Address 1:

End User Address 2:

End User City:

End User State / Province (if applicable)

End User ZIP/Post Code:

End User Telephone:

End User E-mail:

End User Contact Person:

Purchase Order Number:

What product are you manufacturing? (Please list the products that you produce or repair. For Testing Laboratories, please list the products that you commonly test):

Examples: Electric Motors, Air Conditioners, LED Lighting, Wiring Harnesses, Pumps, Heating Elements, etc

Form Completed by:

Your Distributor Name (if applicable):

E-mail for receiving a copy of this statement (optional):

Date:

Ikonix USA commodities, technology or software are exported from the United States in accordance with the Export Administration Regulations. Diversion contrary to U.S. law is prohibited.