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Registration Form
for U.S. Commercial Service's
Platinum Key Service for US Mobile Technologies SMEs
Fields marked with * are required.
OMB Control No.: 0625-0237
Expiration Date: 10/31/12

Contact Information

Company Name:   *
Salutation:  
Full Name:   *
Title:   *
Address:   *
City:   *
State:  
Zip/Postal Code:   *
Country:   *
Phone:      Ext.
Fax:  
Cell Phone:  
Email:   *  Receive a Copy
Confirm Email:   *
Web Site:   *


Company Profile  

Year company was founded:
 
 

Number of employees in the company:*
 

*Type of Business:
 
Manufacturer
Distributor
Service
Other Type of Business: 
 

*Sales Method:
 
Direct
Agents
Distributors
Joint Venture
Other Sales Method:
 

*Your Product's Category (Industry Subsector):
 
 

*Does your product/service contain at least 51% U.S. content?
Yes    No
 
   
Describe your product/service and its innovative features (this is what the mobile network operators will see!)
(limit 250 words):
Your Local U.S. Department of Commerce Office
 
Are you currently working with one of our 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?

 

  

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.