We appreciate your purchase of Anritsu Products. Anritsu has a strict policy that new Anritsu equipment purchased from USA distributors is for USA sale and USA use only.  Please complete the following form and fax it to Amtronix Instruments, Inc. at 716-763-0371.

Company name:_______________________________
Contact person:_______________________________
Address:____________________________________
___________________________________________
__________________________________________
Phone Number:______________________________
Fax Number:_______________________________

I agree that the Anritsu Equipment being purchased is for shippment and use in the USA only.
Signature:__________________________________
Print Name:________________________________
Date:__________________________________

3/03/2004 Amtronix Instruments, Inc.  fax#716-763-9104