Advanced Vacuum Systems, Inc. 60 Fitchburg Road Ayer, Massachusetts 01432 USA
January 10, 2012
SNAP-R BIS Export Approval
Mandatory Information Required
Buyer
Company Name Address, Country & Postal Code Main phone number
Main Buying Contact Name Address, Country & Postal Code Telephone / fax number, email address
Agent Info / Intermediary / Integrator ( if applicable )
Company Name Address, Country & Postal Code Main phone number
Agent Contact Name Address, Country & Postal Code Telephone / fax number, email address
End User / Final Installation Site
Company Name Address, Country & Postal Code Main phone number
Main Technical Contact Name Address, Country & Postal Code Telephone / fax number, email address
Processing Information
End use / materials processed
Phone: 978-772-0710 Fax: 978-772-6462 e-mail: [email protected] Website: www.avsinc.com
D:\Docs\2018-04-04\01466daa083aacbe1760964e1b04d25c.doc Advanced Vacuum Systems, Inc. 60 Fitchburg Road Ayer, Massachusetts 01432 USA
January 10, 2012
Export Control End-Use Statement
Before your order can be processed, please provide the information requested below and have a principal of your company (as the Buyer) endorse this export control end‐use statement that your use, sale or re‐export of these products will not violate U.S. Export Control Regulations.
Please complete and return via fax. to +1 978 772 6462, Attn: Mark Sowerbutts, or email to [email protected]
DATE: COMPANY NAME (Buyer) COMPANY ADDRESS (Buyer)
DELIVERY ADDRESS
PERSON RESPONSIBLE Full Name: Title:
REFERENCE Product Name/ Part Number: PO Number:
PRODUCT APPLICATION A brief description of the product function. Where the product is a subcomponent of a larger system, a description of the purpose/function of the larger system. (E.g. “for use in inertial navigation systems for civil aircraft” – not simply “civil aircraft”)
(The name of the country where your product will be used or sold) COUNTRY OF END-USE
(Enter Yes or No answer) Is this product specially designed or modified for a military, space, satellite, or commercial satellite use?
(Enter Yes or No answer) Is this product intended for use in connection with the development, production, handling, operation, maintenance, storage, detection, identification, or dissemination of CHEMICAL, BIOLOGICAL, or NUCLEAR WEAPONS or OTHER NUCLEAR EXPLOSIVE DEVICES, or the development, production, maintenance, or storage of MISSILES capable of delivering such weapons, or to an end-user or end-use prohibited by U.S. export control laws?
U.S. export control regulations include the Export Administration Regulations (EAR) http://www.bis.doc.gov/ for commercial, industrial and medical applications, and the International Traffic in Arms Regulations (ITAR) http://www.pmddtc.state.gov/ for military, space and satellite applications (including commercial satellite applications).
Phone: 978-772-0710 Fax: 978-772-6462 e-mail: [email protected] Website: www.avsinc.com
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