International Sales Questionnaire
End User/End Use Statement

Northrop Grumman International Trading, Inc (NGIT)

Dear Valued Customer,

Export of these commodities is subject to either the United States Government’s Export Administration Regulations (EAR) or International Traffic in Arms Regulations (ITAR). Please complete and return this statement, so we may complete the review of your purchase order or request for quotation. The information provided within this document will only be used for export control purposes.

Purchaser:


Company Name:

Address:

City: Postal Code: Country:

Phone Number: Website:

Company Description:

Purchase Order Number:

Purchaser will buy which product(s) from NGIT?

Will Products(s) be: / Re-sold / Incorporated into another product before re-sale?

End User: required if different from Purchaser
Note: If multiple end-user in multiple countries, please list on separate sheet

Company Name:

Address:

City: Postal Code: Country:

Phone Number: Website:

Company Description:


International Sales Questionnaire

End User/End Use Statement (continued)

End Use:
Products will be used for:

Commercial / Defense/Military / Aerospace / Other (please specify)

Please provide a detailed technical description of how this NGIT product will be used in the end product.

Please state the full and specific use / application of the end product. If integrated into a laser system, include wavelength, output power, beam quality, repetition rate, duty factor, etc. for the system. Provide end product name and datasheet if available.

The end product will be used in the design, development or production for the following:

Nuclear Weapons / Yes / No / Biological Weapons / Yes / No
Chemical Weapons / Yes / No / Ballistic Missiles / Yes / No

Information provided is true and correct to the best of knowledge. By signing below, your company realizes that these laser products are controlled either by the EAR or ITAR and will comply with all U.S. Export Laws and Regulations.

Signature Required: / Date:
Print or Type Name:
Title:
Company:

Please return completed form by fax +1 636.916.4994 or e-mail..

Northrop Grumman International Trading, Inc NGIT-FORM -0005

Effective Date: 10/12/2015