Fields marked with * are required.
OMB Control No.: 0625-0237
Expiration Date: 4/30/12

Contact and Company Information

Company Name*

Your Name*

Salutation

Title/Responsibility*

Company Address*

City*

State*

Zip Code*

Phone*
Ext.

Fax

Email*

Confirm Email*

Web Site*

 

Company Details

Type of Company

Manufacturer
Distributor
Export Trading Company
Service
Other

 

Year firm was established.

If you are not a manufacturer, do you or your firm have documented right to export the products or services?
Yes No Not Applicable

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

Total Annual Sales

Percentage Export
%

Number of Employees

Sales Method

Direct
Agents
Distributors
Joint Ventures
Other

Do you or your company have an export promotional budget?
Yes No

Company Background

 

Product/Service Information

Product/service name


Industry*
Please describe the industry your product/service is used in.

Description
Please describe your product/service.
 

Users
Please describe the primary users of your product/service.

 

Market information

Your immediate international objectives.


Countries you are currently exporting to.


Countries you would like to target in the next 12-18 months.


Have you proactively exported in the last 12 months?*
Yes No

 

Your Local U.S. Department of Commerce Office

Are you currently working with one of our U.S. Department of Commerce offices/U.S. Export Assistance Centers here in the U.S.*
Yes No

Trade specialist or office*
If yes, please enter the International Trade Specialist with whom you are now working.

Other Trade Specialist or Office
If known, feel free to add the name of your trade specialist if not listed above.


In the past 24 months, have you or has your company utilized any market research reports or trade promotion programs, or received trade counseling from the U.S. Commercial Service or one of its Export Assistance Centers?
Yes No

If so, have these programs or information assisted you in completing any export sales?
Yes No

If time allows, could you explain your export successes as a result of assistance provided by the U.S. Export Assistance Center.

 

 

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.

To the best of our knowledge, the information contained in the reports listed on this page is accurate as of the date published. However, The Department of Commerce does not take responsibility for actions readers may take based on the information contained herein. Readers should always conduct their own due diligence before entering into business ventures or other commercial arrangements. The Department of Commerce can assist companies in these endeavors.

 

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.