SURPLUS CITY JEEP PARTS

4514 PACIFIC HEIGHTS RD – OROVILLE, CA 95965

530-533-2500 – 800-353-3772 – FAX 530-534-6769
www.surplusjeep.com

Date:

Attn: Importer.

From: Export compliance.

Re: End User Certificate and Technology & Software Release Form

Thank you for your order. We have become aware of changed documentation rules for
export to you. Please return the enclosed forms via mail.

The U. S. Bureau of Industrial Security regulates the export of parts that are used to
maintain military vehicles and the printed technical manuals that relate to military
vehicles. Often these parts are interchangeable between military and civilian jeeps.
For this reason we request that our customers outside the U.S. have on file the
documentation that may be appropriate for future orders. Our intent is to maintain this
export documentation in our office so that future orders are not delayed by incomplete
paperwork.

Included in this fax is a Form BXA-711, U.S. Bureau of Information Security, End User
Certificate. We need this original form filled out, signed, dated and returned to our office
before we can ship you parts that go on both military and civilian jeeps. A faxed copy
does not meet the regulation. The document is your assurance that your use of military
parts will comply with U.S. law. This is a blanket certificate and will remain in force for
any future personal purchases of military jeep parts.

The second form is a sample Technology & Software Release Form. This covers any
printed material that relates to military vehicles.

With these two forms returned to our office, we will be able to process any future orders
that you may place with us for your described use. Both parties will have fulfilled the
export documentation obligation under current U.S. export regulations. Thank you for
your understanding and cooperation.
 TSR Letter of Assurance

TO: Surplus City Jeep Parts

Subject: Restricted Technology or Software Received from Surplus City Jeep Parts

Reference: U.S. Export Administration Regulations [§740.6(a)(1)(i)(ii)]

We, __________________________, hereby certify, unless otherwise authorized, that neither the
technology or software not the direct product thereof is intended to be shipped, directly or
indirectly, to:

Group Countries

D-1 Albania, Armenia, Azerbaijan, Belarus, Bulgaria, Cambodia, China (PRC),

Estonia, Georgia, Kazakhstan, Kyrgyzstan, Laos, Latvia, Lithuania,
Moldova, Mongolia, Romania, Russia, Tajikstan, Turkmenistan, Ukraine,
Uzbekistan, Vietnam

E-2 Cuba, North Korea, Libya

Other Iran, Iraq, Syria, Sudan

Respectfully,

_______________________________________________________
(Signature)

Dated: ______________________

Note: This letter should be sent to the U.S. exporter and maintained on by the U.S. Exporter

If you are an overseas company please put this on your company letterhead.
FORM BIS-711 U.S. DEPARTMENT OF COMMERCE DATE RECEIVED
FORM APPROVED UNDER OMB
BUREAU OF INDUSTRY AND SECURITY (Leave Blank)
CONTROL NO. 0694-0021, 0694-0093 Information furnished herewith is subject to the provisions of Section 12(c) of the Export
Administration Act of 1979, as amended, 50 U.S.C. app 2411(c) and its unauthorized
disclosure is prohibited by law.

STATEMENT BY ULTIMATE CONSIGNEE AND PURCHASER

1. ULTIMATE CITY
CONSIGNEE

ADDRESS COUNTRY
LINE 1

ADDRESS POSTAL TELEPHONE

LINE 2 CODE OR FAX

2. DISPOSITION OR USE OF ITEMS BY ULTIMATE CONSIGNEE NAMED IN BLOCK 1

We certify that the items: (left mouse click in the appropriate box below)

A. □ Will be used by us (as capital equipment) in the form in which received in a manufacturing process in the country named in Block 1 and will not be
reexported or incorporated into an end product.

B. □ Will be processed or incorporated by us into the following product (s) _____________________________________________________________

to be manufactured in the country named in Block 1 for distribution in _____________________________________________________________

C. □ Will be resold by us in the form in which received in the country named in Block 1 for use or consumption therein.
The specific end-use by my customer will be_________________________________________________________________________________

D. □ Will be reexported by us in the form in which received to _______________________________________________________________________

E. □ Other (describe fully)___________________________________________________________________________________________________

NOTE: If BOX (D) is checked, acceptance of this form by the Bureau of Industry and Security as a supporting document for license applications shall not be construed as an
authorization to reexport the items to which the form applies unless specific approval has been obtained from the Bureau of Industry and Security for such export.

3. NATURE OF BUSINESS OF ULTIMATE CONSIGNEE NAMED IN BLOCK 1

A. The nature of our usual business is__________________________________________________________________________________________________

B. Our business relationship with the U.S. exporter is _____________________________________________________________________________________

and we have had this business relationship for ____ year(s).

4. ADDITIONAL
INFORMATION
5. ASSISTANCE IN
PREPARING STATEMENT
STATEMENT OF ULTIMATE CONSIGNEE AND PURCHASER
We certify that all of the facts contained in this statement are true and correct to the best of our knowledge and we do not know of any additional facts which are inconsistent with the
above statement. We shall promptly send a supplemental statement to the U.S. Exporter, disclosing any change of facts or intentions set forth in this statement which occurs after the
statement has been prepared and forwarded, except as specifically authorized by the U.S. Export Administration Regulations (15 CFR parts 730-774), or by prior written approval of the
Bureau of Industry and Security, we will not reexport, resell, or otherwise dispose of any items approved on a license supported by this statement (1) to any country not approved for
export as brought to our attention by means of a bill of lading, commercial invoice, or any other means, or(2) to any person if we know that it will result directly or indirectly, in disposition
of the items contrary to the representations made in this statement or contrary to Export Administration Regulations.
6. SIGNATURE OF OFFICIAL OF ULTIMATE CONSIGNEE 7. NAME OF
PURCHASER

NAME OF SIGNATURE OF
OFFICIAL PURCHASER
TITLE OF NAME OF
OFFICIAL OFFICIAL
DATE (mmmm,dd,yyyy) TITLE OF
OFFICIAL
CERTIFICATION FOR USE OF U.S. EXPORTER - We certify that no DATE (mmmm,dd,yyyy)
corrections, additions, or alterations were made on this form by us after the form was
signed by the (ultimate consignee)(purchaser).
8. NAME OF SIGNATURE OF PERSON AUTHORIZED TO CERTIFY FOR EXPORTER
EXPORTER

NAME OF PERSON TITLE OF PERSON SIGNING THIS DOCUMENT DATE (mmmm,dd,yyyy)

SIGNING THIS DOCUMENT

We acknowledge that the making of any false statements or concealment of any material fact in connection with this statement may result in imprisonment or
fine, or both and denial, in whole or in part, of participation in U.S. exports and reexports.
Public reporting burden for this collection of information is estimated to average 15 minutes per Washington, DC 20230, and to the Office of Management and Budget Paperwork Reduction Project (0694-
response plus one minute for recordkeeping, including the time for reviewing instruments, searching 0021, 0694-0093), Washington, D.C. 20503. Notwithstanding any other provision of law, no person is
existing data sources, gathering and maintaining the data needed, and completing and reviewing the obligated to respond to nor shall a person be subject to a penalty for failure to comply with a collection of
collection of information. Send comments regarding this burden estimate or any other aspect of this information subject to the Paperwork Reduction Act unless that collection of information displays a currently
collection of information, including suggestions for reducing this burden, to the Director of valid OMB Control Number.
Administration, Room 3889, Bureau of Industry and Security, U.S. Department of Commerce,