Export.gov - Access 2013 Form

Thank you for registering. We look forward to assisting you with your company market entry strategies. Please take the time to fill out this form and click the submit button at the bottom of the page.

During the One-on-One meetings you will have the opportunity to get specific answers pertaining to your business. Each meeting will be 20 minutes in duration.

The coordinators of this section of the program are available to discuss you needs with you in advance. Please contact:

Shirreef Loza
International Trade Specialist
U.S. Dept. of Commerce --- shirreef.loza@trade.gov

Michael Rosales
International Trade Specialist
U.S. Dept. of Commerce --- michael.rosales@trade.gov

Public reporting for this collection of information is estimated to be 5 minutes per response, including the time for reviewing instructions, and completing and reviewing the collection of information. All responses to this collection of information are voluntary, and will be provided confidentially to the extent allowed by law. Notwithstanding any other provision of law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Reports Clearance Officer, International Trade Administration, Department of Commerce, Room 4001, 14th and Constitution Avenue, N.W., Washington, D.C. 20230.

Company Name:		*
Salutation:
Full Name:		*
Title:		*
Address:		*
City:		*
State:		*
Zip Code:		*
Phone:		Ext.
Fax:
Cell Phone:
Email:		*
Confirm Email:		*
Web Site:		*

Company Profile
Year company was founded:

Number of employees in the company:*

*Type of business:
Manufacturer Distributor	Service Other
*Sales Method:
Direct Agents Other	Distributors Joint Venture
*Please describe your product or service:

*Who are the buyers or end users for your product/service?

*Please select your industry:

*Is your product/service at least 51% U.S. content?
Yes No

Meeting Request / Country Selection
Please select in the order of importance up to five (5) countries for which you would like to meet with our Senior Commercial Officers and Commercial Specialists. The average duration of each meeting is 20 minutes.
1. 2. 3. 4. 5.
If there are additional countries you would like to meet with, please list them below. There will be additional opportunities to meet with the Senior Commercial Officers at the country outlooks, country workshops, during the lunches, and the reception.

Please provide a brief statement on your company's sales activity in each of the markets you selected above:

By market, please specify question/topic you need the Commercial Specialist(s) to be prepared to discuss:

The U.S. Commercial Service has offices at U.S. Embassies in 80 countries (although not all 80 countries will be represented at ACCESS 2012). Can we be of assistance with your exporting efforts to any other markets?

Your Local U.S. Department of Commerce Office
Are you currently working with one of our offices/U.S. Export Assistance Centers in the United States?*
Yes No
If yes, which office or Trade Specialist are you currently working with:

In the past 24 months, have you or your company utilized any market research reports or trade promotion programs, or received counseling from the U.S. Dept of Commerce or one of its U.S. Export Assistance Centers?*
Yes No
If yes, has the program of information provided assisted you in completing your export sales?
Yes No
If time allows, could you please explain?