SNAP-R Export License Form

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BIS-748P
Status: DRAFT

Edit Export License Application
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Contact Information*

W
WIIN
ND
DO
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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

[email protected]

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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Title

Author

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