END USER CERTIFICATE

PLEASE COMPLETE THIS FORM ENTIRELY AND ACCURATELY WITH ALL REQUESTED INFORMATION

If you have any questions about the form fields, please contact sales@blasterstool.com for clarification.

DATE

SKU #

Please enter the SKU# or part number for the product

Quantity

Please enter the quantity

Description

Please describe the product

Who manufactures the product?

Please enter the manufacturers name - if you do not know this information please email sales@blasterstool.com to inquire.

The goods listed above will be used by:

Please enter the company or individual's name. Please include a ny ATF license numbers or other information that may be helpful.

I certify these goods will not be exported, re-exported, or sold for export.

These goods are to be used for the following purpose:

We (I) Confirm that the goods above will not be used for purposes associated with chemical, biological or nuclear weapons, or missiles capable of delivering such weapons, nor will they be re-sold if we suspect that they are intended to be used for such.

Your name:

Your Email Address:

Your Taxpayer ID#

IF you have an order #, PO#, or other reference # please enter it here

By submitting this form I certify that the included information is true and accurate to the best of my knowledge.

END USER CERTIFICATE

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