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Share Your Export Success With Us!
Please complete the following to assist us in our efforts to continually improve the quality and effectiveness of the various export assistance programs and services. Reporting our performance lets us stay in business and continue to assist you. Thank you!

The information you provide will remain confidential and will only be reported in aggregate with all successes from the country. We realize the sensitivity to releasing sales figures and are happy to receive generalized estimates or ranges.
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 Code:*  
Telephone:      Ext.
Fax:  
Cell Phone:  
Email:*      Receive a Copy
Confirm Email:*  
Web Site:  


Company Profile  
Year company was established:*  
 

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  

Percentage export:
 

Total annual sales:*
 

Number of employees in the company:*
 

Do you have an export promotional budget?
Yes    No  

Please select your industry:*
 
 


Company Background*

 

 

Export Description
Did you make your first ever export sale in the past 12 months?*
Yes    No  

Have you appointed agents or distributors abroad?*
Yes    No  

Export experience/objective*
New to export
New to market
Increase to market
 

Countries you did export to*

Amount of export sale*
Please specify the approximate amount in USD (whole numbers only).

How did our office assist you?