Salutation* Mr. Mrs. Ms. Miss Dr.

First Name*

Last Name*

Title*

Company Name*

Company Address*

City*

State* Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin

Zip Code*

Telephone*

Fax*

Email*

Web Site 

Type of Company  Manufacturer Distributor Export Trading Company Service Other

Year the firm was established?*

Are the products/services to be sold at least 51% US content?* Yes No

Total Annual Sales  Under $1 Million $1-5 Million $5-$10 Million $10-$25 Million Over $25 Million

Sales Method  Direct Agents Franchise Distributors Joint Venture Other

Immediate Objective/ Goal 

Worked with Commercial Service 

In the past have you or your firm worked with any of the U.S. Dept. of Commerce offices in the U.S. or abroad or exhibited or participated in a trade event? (Trade shows/Trade missions/Matchmakers)

Yes No

Product/Service Name 

Industry 

Select the primary industry your product/service is used in

Accounting Services Advanced Ceramics Advertising Services Agricultural Chemicals Agricultural Machinery and Equipment Agricultural Services Air Conditioning/Refrigeration Equipment Aircraft/Aircraft Parts Airport/Ground Support Equipment Apparel Architectural/Construction/Engineering Services Artwork Audio/Visual Equipment Automobiles/Light Trucks/Vans Automotive Parts/Services/Equipment Aviation Services Biotechnology Books/Periodicals Building Products Business Equipment (Non-Computer) Chemical Production Machinery Coal Commercial Fishing Equipment Commercial Vessels and Equipment (Non-Fisheries) Composite Materials (Plastic/Ceramic/Metallic) Computer Services Computer Software Computer Software and Services Computers/Peripherals Construction Equipment Consumer Electronics Cosmetics /Toiletries Defense Industry Equipment Dental Equipment Drugs/Pharmaceuticals Economy Education/Training Services Electrical Power Systems Electronic Components Electronics Industry Production/Test Equipment Employment Services Films/Videos Financial Services Fishing Equipment Food Processing/Packaging Equipment Foods - Processed Footwear Forestry/Woodworking Machinery Franchising Furniture General Consumer Goods General Industrial Equipment/Supplies General Science and Technology General Services Giftware Health Care Services Hotel/Restaurant Equipment Household Consumer Goods Industrial Chemicals Industry Not Listed Information Services Insurance Services Investment Services Iron/Steel Jewelry Laboratory Scientific Instruments Lawn/Garden Equipment Leasing Services Leather/Fur Products Machine Tools/Metalworking Equipment Management Consulting Services Marine Fisheries Products (Seafood) Materials Handling Machinery Medical Equipment Mining Industry Equipment Musical Instruments Non-Ferrous Metals Oil/Gas Field Machinery Oil/Gas/Mineral Production/Exploration Services Operations/Maintenance Services Packaging Equipment Paper/Paperboard Pet Foods/Supplies Photographic Equipment Plastics Materials/Resins Plastics Production Machinery Pleasure Boats/Accessories Pollution Control Equipment Port/Shipbuilding Equipment Printing/Graphic Arts Equipment Process Controls - Industrial Pulp/Paper Machinery Pumps/Valves/Compressors Railroad Equipment Regulations Renewable Energy Equipment Robotics Security/Safety Equipment Sporting Goods/Recreational Equipment Telecommunications Equipment Telecommunications Services Textile Fabrics Textile Machinery/Equipment Textile Products - Made-Up Tools - Hand/Power Toys/Games Trade Promotion Services Transportation Services (other than Aviation) Travel/Tourism Services Trucks/Trailers/Buses Used/Reconditioned Equipment Veterinary Medicine Equipment/Supplies Water Resources Equipment/Services Yarns Other

Additional Industries 

Product/ Service Description 

If applicable, please list the countries that you are currently exporting to: 

Please list the countries that you would like to target for export in the next 12/18 months: 

Requests/ Comments/ Questions