Business Service Provider Application

Fields marked with * are required.

OMB Control No.: 0625-0237
Expiration Date: 02/28/2009

Contact and Company Information

Company name*

First name*

Last name*

Salutation  Mr. Ms. Mrs. Miss. Dr.

Title/responsibility 

Company address*

City*

State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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 North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip code*

Phone 

Fax 

Email*

Web site 

Select Your Industry* Accounting Services Advanced Ceramics Advertising Services Agricultural Chemicals Agricultural Machinery & Eq. Agricultural Services Air Conditioning/Refrigeration Eq. Aircraft/Aircraft Parts Airport/Ground Support Eq. Apparel Architectural/Constr./Engineering SVC Artwork Audio/Visual Eq. Automobile/Light Truck/Vans Automotive Parts/Services Eq. Aviation Services Biotechnology Books/Periodicals Building Products Business Eq. (Non-Computer) Chemical Production Machinery Coal Commercial Fishing Eq. Commercial Vessel/Eq. (Non-Fisheries) Composite Materials Computer Services Computer Software Computers/Peripherals Construction Eq. Consumer Electronics Cosmetics/Toiletries Defense Industry Eq. Dental Eq. Drugs/Pharmaceuticals Economy Education/Training Services Electrical Power Systems Electronic Commerce Electronic Components Electronics Industry Prod/Test Eq. Employment Services Films/Videos Financial Services Food Processing/Packaging Eq. Foods - Processed Footwear Forestry/Woodworking Machinery Franchising Furniture General Consumer Goods General Industrial Eq./Supplies General Science & Technology General Services Giftware Health Care Services Hotel/Restaurant Eq. Household Consumer Goods Industrial Chemicals Information Services Insurance Services Investment Services Iron/Steel Jewelry Laboratory Scientific Instruments Lawn/Garden Eq. Leasing Services Leather/Fur Products Machine Tools/Metalworking Eq. Management Consulting Services Marine Fisheries Products (Seafood) Materials Handling Machinery Medical Eq. Mining Industry Eq. Musical Instruments Non-Ferrous Metals Oil/Gas Field Machinery Oil/Gas/Mineral Prod/Explor Serv. Operations/Maintenance Services Packaging Eq. Paper/Paperboard Pet Foods/Supp. Photographic Eq. Plastics Materials/Resins Plastics Production Machinery Pleasure Boats/Accessories Pollution Control Eq. Port/Shipbuilding Eq. Printing/Graphic Arts Eq. Process Controls - Industrial Pulp/Paper Machinery Pumps/Valves/Compressors Railroad Eq. Regulations Renewable Energy Eq. Robotics Security/Safety Eq. Sporting Goods/Recreational Eq. Telecommunications Eq. Telecommunications Services Textile Fabrics Textile Machinery/Eq. Textile Products - Made-Up Tools - Hand/Power Toys/Games Trade Promotion Services Transportation Serv. (other than Aviation) Travel/Tourism Services Trucks/Trailers/Buses Used/Reconditioned Eq. Veterinary Medicine Eq./Supplies Water Resources Eq./Services Yarns

Business Service Providers

Please enter your company's point of contact information and company description in the following fields as you would like the information posted on our on-line Business Service Provider directory(s).

Point of Contact Name*

Point of Contact Title*

Point of Contact Phone*

Point of Contact Fax*

Point of Contact Email Address*

Company Address 

If different than the address provided above.

Short Business Service Provider Description*

Please try to provide a short description less than 75 characters.

Complete Business Service Provider Description*

Please select your Business Service Provider Category* Accounting and Auditing Advertising Banking and Finance Business Administration Services Business Associations Business Consulting Car Rental Chambers of Commerce Computer Services Conference Equipment & Facilitation Debt Collection Distribution Services Electronic Components and Supplies Engineering Services Entertainment Services Health Services Graphic Design Human Resources Hotels and Meeting Facilities Insurance Services Importers and Agents Marketing and Public Relations Legal Services Office Rental Market Research Printing and Publishing Services Mining and Oil and Gas Services Product standards, testing & certification Patent and Trademark law Services Real Estate Services Photographic Services Relocation services Regional Economic Development Retailers Restaurants and Catering Telecommunications Security and Personal Safety Training and Education Services Trade Show and Exhibition Services Transport and Storage Translation and Interpretation Travel Facilitation Other Business Services

Additional Business Service Provider Listings

A Business Service Provider listing in a Pacific Southwest directory is $250. We can list you in additional directories in the Pacific Southwest region for $75 per listing.

Please select Business Service Provider Directory 

Hawaii	Los Angeles (West)
Indio	Nevada
Inland Empire	Orange County
Kern County	San Diego
Los Angeles (Downtown)	Ventura

Your U.S. Commercial Service Contact

Are you currently working with one of our U.S. Department of Commerce offices/U.S. Export Assistance Centers?* Yes No

If yes, please enter the International Trade Specialist and office with whome you are currently working with. 

How were you introduced to our Business Service Provider directories?*

Trade seminar/conference/event	Non-profit trade organization
Federal government agency	Internet research
Local government agency	Referred
Local school/university presentation	Other

Submission of business or personal information is voluntary. Please be aware of our Privacy Policy.

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.