Type and name of service you wish to export?*

*For example: Franchise, IT consulting, engineering services etc.

In what industry is your service?*

*Can be more than one. Please be as detailed as possible.

How would you describe the service you wish to export?*

Have you established a market for your service in the U.S.?*

*Typically, we engage with companies that have been doing business in the U.S. for at least one year.

Yes No

Developing international markets takes time. Is your company willing to invest time and resources for 6 months or more prior to realizing your first sale?*

*Length of time to first sale varies, but the expectation should be that it will take a minimum of 6 months.

Yes No

What is your export promotional budget?* $5,000-$9,999 $10,000-$14,999 $15,000+

Do you have company and service literature, including a website, to provide to potential foreign partners?* Yes No

Total annual sales* Under $1 Million $1-$5 Million $5-$10 Million $10-$25 Million Over $25 Million

Company Background*

Salutation  Mr. Ms. Mrs. Miss. Dr.

First Name*

Last Name*

Company Name*

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 Number*

Fax 

Email*

Web site*

Year company was established?*

Number of employees?* 1-10 11-50 51-100 101-500 501+

Your immediate international objectives*

Countries you are currently exporting to 

Countries you would like to target in the next 12-18 months 

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

Trade specialist or office 

Please enter the International Trade Specialist or nearest U.S. Department of Commerce, Export Assistance Center Office with whom you are now working.

George Tracy John Fleming Dina Molaison Amy Ryan Atlanta Office Savannah Office Other I am not currently working with an Int'l Trade Specialist or Office

Other trade specialist or office 

If known, feel free to add the name of your trade specialist or closest office if not listed above.

In the past 24 months, have you or has your company utilized any market research reports or trade promotion programs, or received trade counseling from the U.S. Commercial Service or one of its Export Assistance Centers?  Yes No

If so, have these programs or information assisted you in completing any export sales?  Yes No

If time allows, could you explain your export successes as a result of assistance provided by the U.S. Export Assistance Center