First Name*

Last Name*

Title*

Company Name*

Company Address*

City*

State*

Zip*

State*

Telephone Number*

Fax*

E-mail Address*

Website*

http://

Product/Service Name*

Product/Service Description*

Who are the Users of your primary product/service?*

Please select your industry sector* 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

Has your company exported before?* Yes No

If yes, please provide the names of the countries to which you exported and the approximate dollar value of hte Company's worldwide exports for the last two calendar years.*

Has the Company exported to any of the locations included in the European Tour?* Yes No

If yes, please provide the approximate dollar value of the Company's exports for each of hte last two calendar years for each trade mission location. 

Are you aready represented in Germany, Belgium or Italy?*

Number of U.S. Employees  1-5 6-20 21-50 51-100 501-1000 1001+

Please describe the nature of Company's/Participant's business as it relates to the goals of this event.*

Please check Company's/Participant's top three objectives for participating in this trade mission.* Finding a sales representative Finding licensees Finding joint venture partners Exposure to new business prospects Product testing/market research Immediate sales Finding a distributor Government meetings Other (specify below)

Please provide a brief description of how Company's/Participant's participation is consistent with the goals and objectives of this event.*

Company/Participant may provide any information that it considers relevant tothe purposes of the specific event regarding diversity and/or traditional under-representation in business.*

For each of hte goods/services that Company/Participant intends to export through this tour is the good/service manufactured inthe United States?* Yes No

If the answer is no for any of the goods or services, are they manufactured or produced outside the United States but marketed under the name of a U.S. firm asnd have U.S> content representing at least 51% value of hte finished good or service?  Yes No

If the percentage of U.S. content is less than 51% of hte value of the finished good or service please explain why the products/wervices should be considered for promotion during this mission 

By checking the below boxes, Company/Participant hereby certifies that* (A) The export of the products and services that it wishes to sell would be in compliance with U.S. export controls and regulations; (B) Company/Participant has identified to the Department of Commerce for its evaluation any business pending before the Department of Commerce that may present the appearance of a conflict of interest; (C) Company/Participant has identified any pending litigation (including any administrative proceedings) to which it is a part that involves the Department of Commerce; and (D) Company/Participant agrees that it and its affiliates (1) have not and will not engage in the bribery of foreign officials in connection with Company's/Participant's involvement in this mission, and (2) maintain and enforce a policy that prohibits the bribery of foreign officials.

In the space provided, please give a detailed description of your company.*

Please include your company's main objective.

What are your company's market advantages?*

Why are you interested in these particular countries?*

What are your company's expectations and goals for this tour?*

What are the most iportant qualifications an appropriate cntact for your firm should have?*

Please indicate the job titles of hte personnel who have the most influence on the purchase of your products.*

(e.g.--engineers, scientists, purchasing agents, plant managers, etc.)

Please provide any additional information that will help us to market your products/services abroad*

(e.g.--U.S. distribution network sturcute, distribution in other international markets)