Export.gov - Long Island Consult Form

Our organization assists export ready companies by optimizing their international business processes, helping identify high-potential target markets and entry strategies, and finding partners in other countries. You must be a U.S. based firm and have at least 51 percent U.S. content of the value of your finished product or service. Our Export Readiness Questionnaire, which precedes the initial consultation, is the first step in this process. Once you complete and submit the survey, one of our Trade Specialists will contact you regarding the next steps.

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.

Company Name:*
Salutation:
Full Name:*
Title:*
Address:*
City:*
State:*
Zip Code:*
Phone:		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*

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:

Market Information

Your immediate international objectives:

Countries you are currently exporting to:

Countries you would like to target in the next 12-18 months:

Have you proactively exported in the last 12 months?*
Yes No

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?

Where did you hear about the U.S. Commercial Service?
Trade seminar/conference/event Federal Government agency Local Government agency Local school/university presentation Non-profit trade organization Internet research Referred Other Which specific event or organization?