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US COMMERCIAL SERVICE

COMPANY QUESTIONNAIRE

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OMB Control No.: 0625-0143
Expiration Date: 1/31/19

Please indicate the service you are interested in:

Gold Key Service International Partner Search

Please indicate the country/countries of interest:

 

Contact Information    
     
Primary Contact    
Salutation
(Mr./Ms./Dr.):*
 
Contact First Name:*  
Contact Last Name:*  
Title within Organization:*  
Email Address:*  
Daytime Phone Number:  
Fax Number:  
Mobile Number:  
     
Alternate Contact    
Salutation
(Mr./Ms./Dr.):
 
Contact First Name:  
Contact Last Name:  
Title within Organization:  
Email Address:  
Daytime Phone Number:  
Fax Number:  
Mobile Number:  
     
Organization Information    
Organization Type:*
Please select all that apply.
 
 

 

 
If Other, please specify.  
Organization Name:*  
Organization Web Site:*  
Organization Address 1:*  
Organization Address 2:  
Organization City:*  
Organization State:  
Organization Zip Code:  
Organization Country:*  
     
Number of employees in Business:*
 
Estimated Annual Sales:*
 
Estimated Percentage of Annual Sales Derived from Exporting:
 
Brief Company Description:*
     
Year Organization Was Established:*
     
Product/Service Information
Select Your Industry:*  
     
Does U.S. content represent at least 51% of the value of the finished product?*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?*   
 
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.
 
Partner Organization
Organization Name:  
Organization Address 1:  
Organization Address 2:  
Organization City:  
Organization State:  
Organization Zip Code:  
Organization Country:  
     
Partner Organization Contact
Salutation
(Mr./Ms./Dr.):
 
Contact First Name:  
Contact Last Name:  
Title within Organization:  
Email Address:  
Daytime Phone Number:  
Fax Number:  
Mobile Number:  
 
Is your representative/partner aware that 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)
 
Your Local U.S. Department of Commerce Office

Are you currently working with a United States Export Assistance Center?
(a.k.a., International Trade Administration, U.S. Commercial Service, Department of Commerce)

Yes  No  

 

  

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.

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  Notice to Visitors!


  The link you have chosen will take you to a non-U.S. Government website.

  If the page does not appear in 5 seconds, please click this: outside web site

  BuyUSA.gov is managed by the International Trade Administration and external links are covered by its website disclaimer statement.