Tell Us About Your Export Success!
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 we offer companies in our area.  Reporting our performance lets us stay in business and continue to assist 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.  

For any questions or concerns, please contact Bill Fanjoy at 703-235-0327.
Fields marked with * are required.
OMB Control No.: 0625-0237
Expiration Date: 4/30/12

Contact Information

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


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  

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?



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.