Export Control Screening Questionnaire
Please complete this questionnaire to assist with export control compliance screening. Accurate responses help us ensure adherence to applicable export regulations.
Full Name
*
First Name
Last Name
Organization Name (if applicable)
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Country of Residence or Business Operation
*
Please Select
United States
Canada
United Kingdom
Germany
France
China
Japan
Australia
Brazil
Other
Nature of Goods, Technology, or Services for Export
*
Intended Export Destination(s)
*
United States
European Union
China
Russia
Middle East
Africa
Other
End-User Name and Address (if different from applicant)
Intended End-Use of Goods, Technology, or Services
*
Are you or your organization affiliated with any individual or entity listed on government restricted or denied party lists?
*
No
Yes (please specify)
Have you or your organization previously been involved in any export control violations or investigations?
*
No
Yes (please explain)
Signature (please sign to confirm your declaration)
*
Submit Screening Questionnaire
Submit Screening Questionnaire
Should be Empty: