End-Use/End-User Statement

Description

In accordance with The Fredericks Company and Televac®’s commitment to compliance with the United States Government export trade regulations, we (the purchasing company) hereby provide the following information regarding the product(s) we are purchasing from The Fredericks Company and Televac®.

Step 1 of 4

Order Information

For online orders, enter your Order Number. Online Order Numbers can be found in your confirmation email or in the My Account section of our website.

End Use Information

Product End Use(Required)
What system is the part being integrated into, and how is it used?

Purchaser Information

Who is placing the order with Fredericks/Televac®?
Purchaser Complete Address(Required)
Is there a broker, freight forwarder, or other intermediary?

Ultimate End Use Information

Who will ultimately receive the order?
Ultimate End User Complete Address(Required)
Consent(Required)

We, the purchasing company listed below, certify that the item(s) being purchased from The Fredericks Company or Televac® will not be re-exported or sold for export without the prior authorization of the U.S. Government or as otherwise authorized by U.S. law and regulations. Furthermore, we confirm that the item(s) will not be used for purposes associated with chemical, biological, or nuclear weapons or missiles capable of delivering such weapons nor will they be resold if we know or suspect that they are intended or likely to be used for such a purpose.

By signing this document, I affirm that all of the above information is true and correct to the best of my knowledge.