Business Service Provider Application

Please complete the application below and download the instructions and payment document at: http://www.buyusa.gov/georgia/bsppayment.doc

Fields marked with * are required.

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 

Company Description for Directory Listing

Limit to 250 words*

Trade References

Provide at least two references of U.S. exporting companies with whom you have conducted business**

DUNS Number

(if available)*

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