Name
Title
Organization
Street address
Address (cont.)
City
State
Zip/Postal code
County
Work Phone
FAX
E-mail
URL

Year Established:

No. of Employees at Location:

Name of Primary Bank:

II. General Sales Information. Please indicate the value of your firm's total sales, and differentiate the amount of exports and/or imports included in total sales. Manufacturers should include direct exports as well as products shipped to exporters. VALUE ESTIMATES WILL BE SUPPRESSED. ONLY THE THE RANGE WILL BE PUBLISHED. PLEAE GIVE DOLLAR AMOUNTS IF SALES EXCEED $1 MILLION.

III. Business Description. Please provide your firm's four-digit Standard Industrial Code (limit four SICs), Harmonized Codes, and describe your products and/or services. If SIC is not known, describe your industry in detail.

4-digit SIC's:

Harmonized Codes:


Products and/or services description:

Please select any of the following categories that describe your firm:

Importer
Exporter
Manufacturer
Retailer
Distributor
Service
Export Trading Company

IV. Trade Information. Please list the brand names your company represents or distributes:

List, in order of importance, up to eight PRODUCTS, PRODUCT CATEGORIES, or SERVICES that your firm markets. For each listing, circle Import from (I), Export to (E), or Both (B).

I E B

I E B

I E B

I E B

I E B

I E B

I E B

I E B

List, in order of importance, up to eight COUNTRIES or REGIONS that your firm trades with. For each listing, circle Import from (I), Export to (E), or Both (B).

I E B

I E B

I E B

I E B

I E B

I E B

I E B

I E B

V. Business Description. Please indicate the primary port of entry/exit for your firm's traded goods.

Port of Entry:

Port of Exit:

Authorization

Name of Authorizing Officer:

Date:

Company Name: