Customer Questionnaire
What's your first name? *
Your answer
What's your last name? *
Your answer
What's your email address? *
Your answer
What's your phone number? *
Please include country code +
Your answer
What is your title or position? *
Your answer
What are your responsibilities? *
Your answer
What is driving your interest in a solution? *
Your answer
What is the likelihood your organization will implement a solution? *
Unlikely
Certain
When are you planning to start the implementation of a solution? *
12+ Months
ASAP
What are your expectations for the investment necessary to purchase a solution? *
< $10K USD
> $2MM USD
How much authority do you have in the selection of a solution? *
None
Final Decision Maker
What's your organization's name? *
Your answer
Which category best describes your organization? *
Is your organization or country restricted in any way with the United States Office of Foreign Asset Control? *
Is your organization restricted in any other way for trade with the United States? *
Does your organization have previous experience purchasing ITAR items or other controlled items from the United States? *
How is your organization legally recognized? *
What's your organization's street address? *
Your answer
What's your organization's state or region? *
Your answer
What's your organization's postal code? *
Your answer
Which country is your organization legally recognized in? *
Which continent does your organization reside in? *
What's your organization's website url? *
Your answer
Accuracy Confirmation
I understand responses are used to ensure compliance with United States laws regarding export of regulated technologies. The responses provided are true to the best of my knowledge and belief.
Export Controls Confirmation
The United States and other governments control export of some technologies as part of an international effort to combat illegal use of weapons. Recipients of controlled items recognize a legal obligation to abide by all laws and regulations both within and outside the United States.

For more information regarding laws, regulations, and policies:

ITAR – International Traffic in Arms Regulations:
http://www.pmddtc.state.gov/regulations_laws/itar.html

U.S. Department of State – Directorate of Defense Trade Controls
https://www.pmddtc.state.gov/

Thank you! Filling this survey will help ensure a timely and informed response.
Submit
Never submit passwords through Google Forms.
This form was created inside of Black Sage. Report Abuse - Terms of Service