Company Name:

Mailing Address:

City:

State:(Select) Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas (except Canada) Armed Forces Europe, Canada, Africa, Middle East Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Telephone:

Fax:

E-Mail:

Website Address:

Main product/service:

SIC code(s):

Schedule B number:

Year established:

Number of employees:

Number of employees dedicated specifically to international:

Average gross annual sales:

% of sales that are international:

How do you currently distribute your product in the United States?

Please list the three major export markets for your products/services (Please list specific countries):

Please list foreign markets your company would like to enter:

In your opinion what are the three greatest export challenges you face?

What type of research would be helpful to your business (e.g.: identification/evaluation of distributors):

Please list the two most pressing international issues facing your company (e.g.: “We need to find a credible distributor in Italy by September” or “We need to set-up a manufacturing facility in China by December”):

Please list any products you import:

Please indicate your interest in the following services to develop your international sales: