*To submit a Declaration of Usage form on a mobile device, please select "view on desktop" below. Then proceed by filling out the form and clicking "submit" when completed.*

Please be aware that the following item(s) or part(s) are either dual usage or military. Consequently, the U.S. Bureau of Export Administration and the U.S. Department of State forbid companies to sell to certain denied countries, entities, or persons.

We are aware of the resale restrictions to parties currently on the Bureau of Export Administration’s Denied Persons List(http://www.bis.doc.gov/DPL/Default.shtm) or Denied Entities List (http://www.bis.doc.gov/Entities/Default.htm), and International Traffic in Arms Regulation (ITAR) (http://www.pmdtc.org).

Please have an officer of your company sign the acknowledgement below, and return a copy by email at orders@access-electronics.com, or fax at 732.446.2892. Also, please check the box below for the statement that applies to your situation.

Declaration of Usage