End User Certificate Please enable JavaScript in your browser to complete this form.Name *Company NameEmail *Tax Payer ID #Model of the Device? *BO199.9-1BO199.9-1MBO1999-1BO1999-10Provide the FULL NAME and PHYSICAL ADDRESS of the End User *The goods will be used for the following purpose: *I certify the goods will not be re-exported or sold for re-export beyond our agreement. *YesWe (I) Confirm that the goods above will not be used for purposes associated with chemical, biological or nuclear weapons, or missiles capable of delivering such weapons, nor will they be re-sold if we suspect that they are intended to be used for such. *YesOrder # / Reference # (optional)By submitting this form I certify that the included information is true and accurate to the best of my knowledge.
