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US Commercial Service GKS Questionnaire
Fields marked with * are required.
OMB Control No.: 0625-00143
Expiration Date: 1/31/15

Contact Information

Company Name:*  
Zip Code:*  
Web Site:  
Contact Person First Name:*  
Contact Person Last Name:*  
Contact Title:*  
Contact Tel:  
Contact Fax:  
Contact Email:*  
Alternate Contact First Name:*  
Alternate Contact Last Name:*  
Alternate Contact Title:*  
Alternate Contact Tel:  
Alternate Contact Email:*  


Company Information  

Number of employees in the company:*

Company Activity:*
(Please select all that apply)
Export Management Company
Service Company

Annual Sales:*
Less than $5 Million
$5-10 Million
More than $10 Million


Annual Exports (as % of Total Sales):
Less than 25%
More than 25%

*Brief Company Description:

Are you currently working with a U.S. Export Assistance Center (USEAC)? Yes    No

If yes, please provide City and Trade Specialist name:

Product/Service Information

*Please select your industry:

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

Describe the product/service(s) you seek to promote including its competitive advantages and unique selling proposition. Include its applications and unique features that differentiate your product from that of the competition.

Who are your major competitors at home and abroad?

List the most important end-users or end-user industries for this product/service.

How is your product typically distributed and marketed in the United States (and in other countries if applicable)?

What type of licensing or registration does it require in the U.S.? (i.e. FDA approval)

What related products might a representative/partner of this product/service also handle?

Does your company produce or have rights to export the product/service? Yes    No

HS Code (optional):

Export Control Classification Code (optional):

Business Objectives

What type of business contacts are you seeking?
Agent/Sales Representative
Joint Venture Partner or Licensee
Other (please specify)

Is your firm seeking representation on an exclusive basis in this market? Yes    No

Describe any preferences, technical qualifications, servicing capabilities, requirements, or pre-qualifications that ideal prospects must have, such as English language ability, size, coverage, investment etc:

Describe any special features of your company's operations, interests, or objectives in the target market that can help us identify potential business partners:

Are there any specific companies, or types of companies, you would like us to contact? If so, please name them.

Local Partner Information

Is your company currently represented in this country/region ? Yes    No

If yes, is this arrangement exclusive ? Yes    No

If applicable, please provide the necessary contact information of your current representative/partner
Company Name:  
Zip Code:  
Contact Person First Name:  
Contact Person Last Name:  
Contact Person Title:  
Contact Tel:  
Contact Fax:  
Contact Email:  
Is your representative/partner aware you are seeking additional representation? Yes    No
Desired Date of Service  
Alternative Dates  
Desired Locations  
Additional Services(please note any other assistance that would be required)


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.