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BIS-748P
Status: DRAFT
Edit Export License Application
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Contact Information*
W
WIIN
ND
DO
OW
W
STELA
STELAO
OPPEENNSS
Export License Application
Reference Number: ACEL001
Reference Number*(XXXXXX)
A
A N
NEEW
W
ACEL001
1. Contact Person (First, Last)*
Al
Che
2. Telephone Number*
2025551212
3. Fax Number
Email
johndoe@companyname.com
4. Creation Date
07/17/2019
5. Type Of Application
Export License Application
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Document Checklist
7. Documents on file with applicant
6. Documents submitted with application
Export Items (BIS-748P-A)
BIS-711
End Users (BIS-748P-B)
Letter of Assurance
BIS-711
Import/End-User Certificate
Import/End-User Certificate
Nuclear Certification
Technical Specification
Other
Letter of Explanation
Foreign Availability
Other
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License Information
9. Special Purpose
10. Resubmission ACN
11. Replacement License Number
13. Import Certificate Country
Please Select
Import Certificate Number
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Company Designation Information
Switch to third party submission
You are currently submitting as a First Party
Applicant Information *
* Required field
14. CIN (Applicant ID)*
A719924
Applicant*
AC & DW Enterprises, Inc
Address Line 1*
8006 River Field Ct
Address Line 2
City*
Bowie
State/Province* (Required for US address)
Maine
Postal Code*
20715
Country*
UNITED STATES
EIN
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Other Party Information
* Required field (only if entering an Other Party). Otherwise leave blank.
15. Other Party ID
Other Party*
Address Line 1*
Address Line 2
City*
State/Province* (Required for US address)
Postal Code*
Country*
Please Select
Telephone or Fax*
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Purchaser Information
* Required field (only if entering a Purchaser). Otherwise leave blank.
16. Purchaser*
Address Line 1*
Address Line 2
City*
Postal Code
Country*
Please Select
Telephone or Fax
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Intermediate Consignee Information
* Required field (only if entering an Intermediate Consignee). Otherwise leave blank.
17. Intermediate Consignee*
Address Line 1*
Address Line 2
City*
Postal Code
Country*
Please Select
Telephone or Fax
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Ultimate Consignee Information*
* Required field
Note: Please enter the Company, Institution, or Organizational information in block 18. Laboratory, Department, or Section information can be
entered as the second line of the address. Any additional information regarding individuals in the organization can be entered in the Additional
Information section (block 24) of this form.
18. Ultimate Consignee*
Address Line 1*
Address Line 2
City*
Postal Code
Please Select
Country*
Telephone or Fax
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End User Information
Enter information for a new End User
* Required field (only if entering an End User). Otherwise leave blank.
Note: End User information should only be entered if the Ultimate Consignee in block 18 is not the actual End User.
19. End User*
Address Line 1*
Address Line 2
City*
Postal Code
Please Select
Country*
Telephone or Fax
Add End User
Specific End Use*
21. Specific End Use*
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Export Item Information*
Enter information for a new Export Item
22. a. ECCN*
Please Select
b. APP(9.9999999)
c. Product/Model Number
d. CCATS Number
e. Quantity*
0
f. Units
each
g. Unit Price
0.0
h. Total Price*
Calculate
Note-BIS will process license applications for items with a total price of zero only in
limited circumstances (e.g., aircraft or vessels on temporary sojourn to Country
Group E destinations). Please, ensure the total price of your application is correct
before submitting to BIS.
i. Manufacturer
j. Technical Description*
Add Export Item
Total Application Dollar Value
23. Total Application Dollar Value
$0.00
Additional Information
24. Additional Information
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Documents attached to application
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Type
File Type | application/pdf |
File Title | Edit Work Item |
Author | mva.maryland.gov |
File Modified | 2019-07-17 |
File Created | 2019-07-17 |