End Use and End User Certification Form

This form must be completed in order to process your purchase/repair order.

Company Name *

Phone Number

PO Number *

Serial Number *

It's AeroWorx's policy to verify the end use and end user in all product sales to ensure compliance with applicable U.S. export control laws and regulations. Because the products you are purchasing may be ITAR controlled, please confirm the following:

For Items Being Exported Out of the United States

Export License Number

Export License Expiration Date

If NLR (No License Required) - Please Enter Exemption Number

Please upload a scan of your export license as a PDF document. Alternately, you can fax a copy of your license to: 310-891-1248.

Ultimate Destination Country *

Ultimate End User *

Ultimate End Use (Aircraft Identification, etc) *

Certification For All Items

I hereby certify that products purchased and/or repaired by your company will not be used for any nuclear, missile, chemical or biological weapons of mass destruction nor will they subsequently be re-exported to parties for the use on nuclear, missile, chemical or biological weapons of mass destruction or to entities on the denied parties list as per the general prohibitions of the U.S. Export Administrative Regulations.

I also acknowledge that the part/s sent to be serviced by and/or purchased from AeroWorx, Inc. are controlled by the International Traffic in Arms Regulations (ITAR) 22 CFR 120‐130. It is our responsibility to obtain any necessary export license/s in order to export, resell or otherwise. We agree not to show AeroWorx, Inc. as an exporter or USPPI on any document.

I certify that I am an authorized official and able to sign this statement on the behalf of my company.

I certify that I am duly authorized to make this decision on behalf of the company below.

By typing my name below, I certify that the above statement is true.

Company Name

Authorized Company Official Name *

Authorized Company Official Title