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

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


Contact Information

 Company Name:*  
Full Name:*  
Zip Code:*  
Phone:      Ext.
Cell Phone:  
Email:*      Receive a Copy
Confirm Email:*  
Web Site:  
Additional Company Representative:  

Company Profile
Year company was established:*  

Type of company*:
Export trading company

Sales Method:*
Joint Venture

*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?




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