Tell Us About You

Our staff prepares to assist export ready companies by assessing the firm's current interest and needs, previous international experience and organizational/product capabilities. This survey, which precedes the initial consultation, is the first step in this process. Please complete the following survey, submit it, and a trade specialist will contact you after reviewing the information provided.

Fields marked with * are required.
OMB Control No.: 0625-0237
Expiration Date: 1/1/15

 

    Contact Information
Salutation
(Mr./Ms./Dr.):*
 
Contact First Name:*  
Contact Last Name:*  
Title within Organization:*  
Email Address:*    Receive a Copy
Daytime Phone Number:  
Fax Number:  
Mobile Number:  
     
    Organization Information
Organization Type:  
Cooperative/Consortium
Education
Franchise
Manufacturer
Reseller
Trading
 
Distributor
Educational Institution
Importer
Minority-Owned
Service Provider
Wholesaler
 
Organization Name:*  
Organization Web Site*:  
Organization Address 1:*  
Organization Address 2:  
Organization City:*  
Organization State:  
Organization Country:*  
Organization Zip Code:  
Number of employees in Business*:  
Estimated Annual Sales:  
Less than $500,000
$1 Million to $2.5 Million
$5 Million to $7.5 Million
$10 Million to $25 Million
$50 Million to $100 Million
More than $250 Million
$500,000 to $1 Million
$2.5 Million to $5 Million
$7.5 Million to $10 Million
$25 Million to $50 Million
$100 Million to $250 Million
Unknown
 
*Select Your Industry:  
Countries Your Business is currently Exporting to (select up to 5):  
Year Organization Was Established:  

 

Company Profile

Type of company*:
 
Manufacturer
Distributor
Export trading company
Service
Other  

Sales Method:*
 
Direct
Agents
Distributors
Joint Venture
Other

*If you are not a manufacturer, do you or your firm have documented right to export the product or service?*
Yes    No    Not applicable  

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

Estimated Percentage of Annual Sales Derived from Exporting:
 

Do you have an export promotional budget?
Yes    No  


Company Background*

 

Product/Service Information
Product/Service name

Please select the industry your product/service is used in*

Please describe your product/service:

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 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?
Where did you hear about the U.S. Commercial Service?
Trade seminar/conference/event
Federal Government agency
Local Government agency
Local school/university presentation
Non-profit trade organization
Internet research
Referred
Other
Which specific event or organization?

 

 

  

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.