End Use Statement
The End User identified below acknowledges that the Deliverables identified below are subject to U.S., European Union (“EU”),
United Nations (“UN”), and other applicable export control, import, and economic sanctions laws and regulations. End User agrees to
comply with all such applicable laws and regulations, including the U.S. Export Administration Regulations (“EAR”) and regulations
administered by the U.S. Department of the Treasury’s Office of Foreign Assets Control (“OFAC”).
Legal Name of Authorized Distributor or Reseller
(Insert “N/A” if ordering direct from KOHLER):
End User Name and Registration/Tax#:
Kohler/Subsidiary Products Being Ordered (the
“Deliverables”):
Purchase Order, Contract, or Other Identifier:
Legal Names and Roles of Banks:
Legal Names and Roles of Forwarders:
Legal Names and Roles of Purchasers (Bill To):
Legal Names and Roles of Intermediaries:
Legal Names and Roles of All Other Parties to the
Transaction:
End Use of the Deliverables:
Delivery and End Use Address(es):
Specific Entity, Affiliate, Division, or Branch that
will be Using the Deliverables:
End User specifically agrees not to, directly or indirectly, (i) export, reexport, transfer (in-country), sell, lease, supply, or allow access
to or use of the Deliverables to, in, by, or for any sanctioned, embargoed, or prohibited country, region, person, or end use under U.S.
or other applicable law; or (ii) engage in any other transaction (i.e., sell, transfer, reexport) requiring a government license or other
approval, unless approved by the relevant government authority or otherwise authorized by law.
End User also certifies that End User is not (i) subject to U.S., EU, UN, or other applicable sanctions or export restrictions; (ii) owned,
directly or indirectly, by any individual or entity located or headquartered in a country or region subject to comprehensive or near-
comprehensive U.S. or other applicable sanctions; or (iii) part of the national armed services, national guard, national police, or a
government intelligence or reconnaissance organization in Belarus, Burma, Cambodia, the People’s Republic of China, the Russian
Federation, or Venezuela; or otherwise qualifying as a military end user or military-intelligence end user in the aforementioned countries
such as by developing, producing, maintaining, or using military items.
End User acknowledges that KOHLER or its subsidiaries may terminate any Purchase Order and/or stop any shipments that it reasonably
believes would be in violation of applicable export control, import, or sanctions laws. This includes any laws and regulations that came
into effect after acceptance of a Purchase Order but before shipment of the Deliverables.
By signing this statement, I certify that all statements herein are true, correct, and complete to the best of my knowledge; that End User
will immediately notify KOHLER or its Authorized Distributor/Reseller identified above (which is, in turn, required to provide such
notification to KOHLER) in writing if any information provided in this end use statement changes; and that I am a duly authorized
representative of End User with the authority to make and sign representations and certifications on behalf of End User.
Authorized End User Signature
{Company Seal}
Printed Name
Title
Date
Internal Communication: For internal & partner use only.
End Use Statement Rev. 1
