BXA-711
Instructions for filling out the End User Statement:
BLOCK 1) Ultimate Consignee – Your company name and address
BLOCK 2) Disposition – How will you be dispersing the product? If resale Check Box C..
BLOCK 3) Nature of Business – This is your company information
BLOCK 4) Additional Information – This is any information that you feel is important and can help
with expediting the License
BLOCK 5) Assistance in Preparing Statement – If someone else prepared the statement for
occupation goes in this space
BLOCK 6) Signature of Official of Ultimate Consignee – This is the signature and title of someone
representing your company
BLOCK 7) Name of Purchaser – This is the Name of the Organization you are selling too, Signature
and Title of a representative working for the organization
BLOCK 8) Name of Exporter – Our company fills out and signs before submitting the form.