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U.S. Export Control Information Request Form




  • For additional rows, please click on the '+'.
  • We ask that you provide specific information regarding each product that you are ordering from Positronic. Even though the subsystem/system or platform may be subject to the U.S. Department of State’s International Traffic in Arms Regulations (ITAR), the product itself may be subject to U.S. Department of Commerce’s Export Administration Regulations (EAR) if the component into which it is incorporated is subject to the EAR. In short, if we cannot properly classify the component and know what platform in which it is used, it is very difficult to classify the product we are manufacturing for you that is a part of the component and therefore to know what U.S. export control licensing requirements apply. Identify Component, Subsystem/System, and Platform/End Product into which Product will be incorporated. For additional rows, please click on the '+'.
    Part NumberCustomer Part NumberProduct DescriptionComponentSubsystem or SystemPlatform/End ProductITAR USML/EAR CCL Classification 
  • With respect to any of the products listed above that are classified under the Commerce Control List, please check any boxes below that apply regarding the ultimate end-use or end-user of the product. If none of the boxes apply to the products, please check none. In the additional field provided below, please explain the reason you checked any of the foregoing boxes relating to the EAR's General Prohibitions on End-Uses and End-Users.

    Because U.S. export and re-export control also require licensing for specific end-uses and end-users, please list below the names and addresses of the parties to the supply chain through which the product(s) will pass. For additional rows, please click on the '+'.
  • NameAddressCityState/ProvincePostal CodeCountry 
  • NameAddressCityState/ProvincePostal CodeCountry 
  • NameAddressCityState/ProvincePostal CodeCountry

    I hereby certify that I am authorized by my company to provide the foregoing information, that the information provided is accurate and complete, and that my company undertakes to inform you immediately of any subsequent change(s) thereto.
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