Form ITA-725P Application for the President's "E" and "E Star" Awards

OMB No. 0625-0065, FORM ITA-725P, U.S. DEPARTMENT OF COMMERCE (Rev. 01-03), INTERNATIONAL TRADE ADMINISTRATION

APPLICATION FOR THE PRESIDENT'S "E" AND "E STAR" AWARDS FOR EXPORT EXPANSION
No E Award will be considered unless a completed application form has been received (E.O. 10978)
By submitting this application, the applicant authorizes Federal Departments, Agencies, and Commissions to provide the U.S. Department of
Commerce with information pertaining to the applicant for purposes of determining the applicant's eligibility and fitness to receive the award
for which it is applying.
Item 1. ORGANIZATION INFORMATION:

Item 4. TYPE OF ORGANIZATION:

Organization Name:
Division or Subsidiary of:
Street Address:
Street Address:
City, State, Zip:
Telephone:

Is your firm listed on a public securities exhange or otherwise reporting to the SEC?
Yes

No

Item 5. EMPLOYEES:

Fax:
Company Web Site:
Tax ID number:

Total number of employees . . . . . . . . . . . . . . . . . . . . . . . . .

__________

Number of employees whose jobs are
attributable to exporting . . . . . . . . . . . . . . . . . . . . . . . . . . . .

__________

Item 6. MAJOR PRODUCTS EXPORTED:
Item 2. CONTACT INFORMATION:
Name of President/CEO:
Name of International Marketing Manager:
Application Point-of-Contact (POC):

NAICS category (ies):

POC telephone:
POC fax:
POC email:

Item 3. SIGNATURE:
I have reviewed the information provided in this application and, to the
best of my knowledge, all the information provided is true and correct. I
understand that this application will be reviewed by an Interagency
Review Committee.

__________________________________________________________
Signature of Organization President/CEO
Date

Item 7. U.S. EXPORT ASSISTANCE CENTER (USEAC)
RECOMMENDING AWARD
USEAC name:
USEAC Director name:

__________________________________________________________
Signature of USEAC Director
Date

Public reporting for this collection of information is estimated to be 27 hours per response, including the time for reviewing instructions, and completing and reviewing the collection of
information. All responses to this collection of information are voluntary, and will be provided confidentially to the extent allowed by law. Notwithstanding any other provision of law,
no person is required to respond to nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork
Reduction Act unless that collection of information displays a current valid OMB Control Number. Send comments regarding the burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden, to the Reports Clearance Officer, International Trade Administration, Department of Commerce, Room 4001,
14th and Constitution Avenue, N.W., Washington, D.C. 20230.

Item 8. APPLICATION FOR (choose one):
The President’s “E” Award
The President’s “E” Award for Export Service
The President’s “E Star” Award for Exports
The President’s “E Star” Award for Export Service

Item 9. EXPORT STATISTICS:
Give figures for each of the four (4) past years, plus latest quarterly data. Data should include shipments to Canada and Mexico, but not
Puerto Rico or the U.S. Virgin Islands. If you wish this information treated as BUSINESS CONFIDENTIAL, please so indicate by checking
the box below. Except where required by law, no information nor data for which the applicant has requested BUSINESS CONFIDENTIAL
treatment will be disclosed to persons not involved in processing this application without the applicant's prior written consent.

BUSINESS CONFIDENTIAL
YEAR

TOTAL SALES

EXPORT SALES

PERCENTAGE OF EXPORTS
TO TOTAL SALES

INCOME FROM
LICENSING AGREEMENTS

Item 10. KEY EXPORTING CHALLENGES:
Check key exporting problems met:

(Include in Item 11 a candid discussion of how you met these challenges)

Obtaining foreign distribution

Import quotas

Specifications

Corporate Organization

Packaging

Foreign Production

Delivery

Product Design

Credit terms/financing

Selecting export channels of distribution

Pricing

Market Research

Tariff barriers

Spare parts and servicing conditions

Dealer relations

Foreign language requirements

Non-tariff barriers

Foreign Competition

Standards

Export and/or import licensing

Required changes in manufacturing process

Documentation

Others (specify)

Item 11. JUSTIFICATION FOR AWARD: (Please attach to nomination form. See Instructions for guidance with writing Justification.)

TO BE TYPED ON COMPANY OR ORGANIZATION LETTERHEAD
In connection with the above-named company's (or organization's) application to the Department of
Commerce for the President's "E" or "E Star" Award, I am signing this waiver to permit the Internal
Revenue Service (IRS) to release otherwise confidential tax information about the company (or
organization ) to appropriate officials of the Department of Commerce. This waiver is made pursuant to
26 U.S.C. 61038 and is limited to the following:
1.

Whether this company (or organization) has failed to file a Federal income tax return for any
of the last three years for which filing of a return might have been required. (If the filing date,
without regard to extensions, and normal processing period for the most recent year's return
has not yet elapsed on the date IRS receives this waiver, and the IRS records do not indicate
a return for the most recent year, the "last three years" will mean the three years preceding
the year for which returns are currently being filed and processed.)

2.

Whether there is any tax, penalty or interest liability for which the IRS gave notice of the
amount due and requested payment that has been outstanding for more than 180 days and
has not yet been paid.

3.

Whether this company (or organization) has been or is under investigation by the IRS for
possible criminal offenses.

4.

Whether this company (or organization) has been assessed any civil penalty for fraud during
the current or last three calendar years.

In the event of an adverse response to any of the above (negative to subparagraph 1 or affirmative to
subparagraph(s) 2, 3, or 4), I hereby authorize the Internal Revenue Service to provide to the Department
of Commerce, upon request, additional tax information pertaining to such adverse response.
To assist the Internal Revenue Service in locating the Federal tax information, I am voluntarily providing the
following information regarding the company (or organization):
Name of Company______________________________________________________________________
Employer Identification Number (EIN): ______________________________________________________
Address: _____________________________________________________________________________
Returns required to be filed: ______________________________________________________________
_____________________________________________________________________________________
If consolidated corporate income tax returns were filed for any of the years covered by No. 1 above,
complete the following:
Name of parent company:________________________________________________________________
EIN of Parent Company__________________________________________________________________
Year(s):_______________________________________________________________________________
If an income tax return for any of the last three years was not filed, please explain why (e.g., a non-profit
organization):_________________________________________________________________________
If signing as a corporate officer, partner, tax matters partner/person, I certify that I have the authority to
execute this form on behalf of the taxpayer.
(Signature)______________________________
(Title)__________________________________
(Date)__________________________________