Submit your application by completing the form below.

Please direct application questions to Diane Mooney.

Diane Mooney, Director
U.S. Export Assistance Center
Seattle, Washington
(206) 553-5615, Ext. 236
Diane.Mooney@trade.gov

Fields marked with * are required.
OMB Control No.: 0625-0237
Expiration Date: 1/1/12

APPLICATION

Contact Information

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


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  


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:

 

Objectives in South Africa
 
What are your company's primary business development objectives in South Africa?

Company's goals in South Africa.

Description of product's and/or company's competitive advantage in South Africa.
 
Principal competitors in South Africa.
 
Are you currently doing business in South Africa?
Yes  No
 
Contact information of agent(s) and/or distributor(s) in South Africa.
 
Can we contact them if necessary?
Yes  No
 
What type of business contacts are you seeking? Distributor, agent/representative, JV partner, direct sales, or other
 
Are there any specific companies or types of companies, you would like us to contact? If so, please name them
 
Related products that might also be handled by an agent/distributor for your products.
 
Specific questions we should ask potential distributors.
 
Additional comments or information you would like us to be aware of about your company.

 

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?

 

 

  

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.