BUYUSA.GOV -- U.S. Commercial Service

Nederland

Business Service Provider Request Form

Each entry will be valid for one year. Payment: $200 to be paid via credit card.


Please note we reserve the right to request trade references and to refuse registrations if they are inconsistent with U.S. Department of Commerce, U.S. Embassy and U.S. Commercial Service regulations.
Fields marked with * are required.

BUSINESS SERVICE PROVIDER CONTACT AND COMPANY INFORMATION

Company Name:*  
Full Name:*  
Salutation:  
Title/Responsibility:*  
Company Address:*  
City:*  
State/Province:*  
Zip Code:*  
Country:*  
Phone*:  
Fax:  
Email:*  
Website:  
Number of Employees*  

CONTACT AND SERVICE INFORMATION AS IT SHOULD APPEAR ONLINE

Please enter your company’s contact information and company description in the following fields, as you would like the information posted on our online Business Service Provider directory.
Contact Full Name:*  
Title:*  
Contact Phone*:  
Contact Fax:  
Contact Email:*  
Company Address(If different than above address):  
City:  
State/Province:  
Zip Code:  
Country:  

Short Business Service Provider Description*

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

Complete Business Service Provider Description*
Describe your company and the service you provide in 500 characters or less. This description may be edited for length and clarity. Please e-mail an electronic copy of your logo as a .jpg or .gif document (save as web file) with a width of exactly 200 pixels and height of up to 200 pixels to your Commercial Service contact.

Business Service Provider Categories*
I agree to pay *** for each category I choose*

Please select applicable categories from the list provided below.

Trade References
Please provide at least two references of companies with whom you have conducted business, U.S. companies if possible.
How did you learn about this program?*