First Name*

Last Name*

Title*

Company Name*

Company Address*

City*

State*

Zip*

Telephone Number*

Fax 

Email Address*

Website 

Product/Service Name*

Product/Service Description*

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

HS Code 

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

Please select your indusry 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

Company Activity 

Select all that apply

Manufacturer	Service Company
Exclusive Distributor	Franchisor
Export Management Company	Other (please specify)

Other 

Number of U.S. Employees*

1-5	101-500
6-20	501-1000
21-50	1001+
51-100

Has company exported before?* Yes No

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

Please describe the nature of the Company's business, as it relates to the goals of this trade mission*

(e.g., Company is a manufacturer of telecommunications equipment which is bidding on a contract to provide cellular phone equipment to Country A.)

Please provide a brief description of how Company's participation is consistent with the goals and objectives of this mission, as set forth in the accompanying mission statement.*

Company may provide any information that it considers relevant to the purpose of the trade mission regarding and/or traditional under-representation in business.*

Has the Company exported to any of the destinations to be visited by this trade mission?* Yes No

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

Are you already represented in any of the trade mission locations?* Yes No

If yes, please provide the full contact information for each of your representatives and indicate if they are aware of your participation in this event. 

Please check Company's/Participant's top three objectives for participating in this trade mission.*

Finding a sales representative	Immediate sales
Finding licensees	Finding a distributor
Finding joint venture partners	Government meetings
Exposure to new business prospects	Other(specify below)
Product testing/market research

For each of the goods/services that Company/Participant intends to export through this trade mission, is the good/service manufactured in the 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 and have U.S. content representing at least 51% value of the finished good or service?  Yes No

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

Who are your major competitors at home and abroad?*

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

How is your product typically distributed and marketed in the U.S. (and other countries is applicable)?*

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

What related products might an agent/distributor of this product also handle?*

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

Please describe any preferences, requirements, or pre-qualifications ideal prospects must have, such as English language ability, size, coverage, investment etc. 

Please 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.

Are there any specific companies, or types of companies, you would NOT like us to contact? 

If so, please name them.

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

If yes, is your distributor aware you are seeking additional representation?  Yes No