Please indicate the country/countries of interest* Japan Korea Taiwan

Company Name*

Address*

City*

Zip Code*

Company Web Site 

Contact Person*

Title*

Contact Tel*

Contact Fax 

Contact Email*

Company Activity*

Please select all that apply

Manufacturer	Service Company
Distributor/Representative	Franchiser
Export Management Company	Other

Number of Employees (est.)*

Annual Sales* Less than $5 Million $5-10 Million More than $10 Million

Annual Exports (as % of Total Sales)*

Less than 25% More than 25%

Brief Company Description*

Are you currently working with a U.S. Export Assistance Center?* Yes No

If yes, please provide City and Trade Specialist name 

Does your product contain at least 51% U.S. content?* Yes No

Product/Service(s) Description*

Describe the product/service(s) you seek to promote including its competitive advantages and unique selling proposition. Include its applications and unique features that differentiate your product from that of the competition.

Who are your major competitors at home and abroad?*

List the most important end-user industries for this product/service.*

How is your product typically distributed and marketed in the United States?*

(and in other countries if applicable)

What type of licensing or registration does it require in the U.S.? 

(i.e. FDA approval)

What related products might a representative/partner of this product/serivce also handle? 

Does your company produce or have rights to export the product/service?* Yes No

HS Code 

(optional)

Export Control Classification Code 

(optional)

What type of business contacts are you seeking?*

Distributor / Wholesaler	Joint Venture Partner or Licensee
Agent / Sales Representative	Other
Franchisee

Is your firm seeking representation on an exclusive basis in this market?* Yes No

Preferences 

Describe any preferences, technical qualifications, servicing capabilities, requirements, or pre-qualifications that ideal prospects must have, such as English language ability, size, coverage, investment etc.

Describe any special features of your company's operations, interests, or objectives in the target market that can help us identify potential business partners. 

Are there any specific companies, or types of companies, you would like us to contact? If so, please name them. 

Is your company currently represented in this country/region?  Yes No

If yes, is this arrangement exclusive?  Yes No

If applicable, please provide the necessary contact information of your current representative/partner 

Is your representative/partner aware you are seeking additional representation?  Yes No

Desired Dates for Service*

Alternative Dates*

Desired Locations*

Additional Services 

(please note any other assistance that would be required)

Interpreter*

For meetings that will require interpretation will you hire an interpreter from an agency, or bring your own interpreter?

I will hire interpreter I will bring my own interpreter

Webposting*

The Gold Key Service includes a listing for your company in our website. Does your company wish to be listed in our website?

Yes No