Customized Services Form

OMB Control No.0625-0143 Expiration Date: xx/xx/xxxx

CUSTOMIZED SERVICES FORM

Company Name: __________________________________________________________________

Street Address: ___________________________________________________________________

City: ______________ State: ______ 9-Digit Zip Code: ______________

Contact Person: ___________________________________________

Telephone: ________________ Fax: _________________________

E-mail: ___________________ Company Web-site Address: _______________

Number of Employees: __________

Type of business:

manufacturer _____ representative/distributor _____

export trading company _____ service provider _____

other (please describe) _____

Total Sales: $__________ % of Sales from Exporting: _______ Total Years Exporting:_______

PRODUCT INFORMATION/READINESS

1. Product or service you wish to export: ______________________________________________

2. Describe your product/service’s benefits and unique features: ____________________________

______________________________________________________________________________

3. a. If your company does not manufacture the product you wish to export, please provide name of manufacturer and location of headquarters:__________________________________________

_____________________________________________________________________________

b. If not the manufacturer, does your firm have documented export rights to product?

_____ Yes _____ No

c. If export rights are limited to a number of countries, please list: _______________

___________________________________________________________________

4. a. Is the company’s product sourced/produced entirely in the United States?

_____ Yes _____ No

b. If part of the product is source/produced outside the United States, does U.S. content represent at least 51% of the value of the finished product?

_____ Yes _____ No

5. Does the product require any special technical support or after-sales service?

_____ Yes _____ No

6. Please list the end users and/or industries in which the product is used: ___________________

________________________________________________________________________________

6. Is your company willing to modify its product to meet foreign standards (i.e. metric system, CE mark compliance with foreign government regulatory agencies, etc.)?

_____ Yes _____ No

6. a. Does the product have patent/trademark/copyright registration in the United States?

_____ Yes _____ No

b. Will patent/trademark/copyright protection abroad be necessary for the product?

_____ Yes _____ No

6. Can the company promptly fill any new export orders from its present inventory?

_____ Yes _____ No

6. Is your company ISO 9000 registered?

_____ Yes _____ No

6. If your company is working towards certification, in what year will this be completed? ___________

EXPORT OBJECTIVE/RESOURCES:

1. Firm’s objective to export (choose all that apply):

___ Increase sales and profits ___ Sell excess inventory

___ Gain global market share ___ Meet foreign competition

___ Reduce dependence on existing domestic markets ___ Absorb excess capacity

___ Stabilize market fluctuations

___Other: (explain) _________________________

2. How would you describe your firm’s top management commitment to supporting export activities?

___ Very important

___ Somewhat important

___ Will respond to unsolicited export orders but will not actively

pursue export markets

___Not important

3. Does your firm have a domestic marketing plan?

_____ Yes _____ No

4. Does your firm have an international marketing plan?

_____ Yes _____ No

If no, does your company need assistance developing one?

_____ Yes _____ No

5. What are the company’s international sales objectives for the next 3 years (as percentage of total sales)?

Year 1: _______________________________________

Year 2: _______________________________________

Year 3: _______________________________________

6. What prompted your company to export?

_____ Contacted by overseas buyer

_____ Via the Internet

_____ Overseas trade show lead

_____ Referral

_____ Assistance from the U.S. Dept. of Commerce or other

State agency

_____ Other (explain) _____________________________________

7. How is your company planning to develop sales in target markets?

_____ Obtain list of potential direct purchasers/direct mail campaigns

_____ Via the Internet

_____ Identify agent/distributors

_____ Exhibit at trade shows

_____ Participate in trade mission

_____ Place ad in trade journals in target market(s)

_____ Travel and meet with potential business contacts

_____ Other (explain) _____________________________________

DISTRIBUTION CHANNELS

1. What domestic channels of distribution does your company employ?

____ Agent ____ Dealer ____ Distributor ____ Catalog/Mail Order/Direct Mail

____ Direct ____ Independent Representative ____ Other _____Franchise

2. If currently exporting, what are your company’s international channels of distribution?

____ Agent ____ Dealer ____ Distributor ____ Catalog

____ Direct ____ Independent Representative ____ Other _____Franchise

PROMOTIONAL METHODS

1. What promotional methods does your company use domestically:

_____ Advertising (trade journals, etc.)

_____ Trade Shows (list) _________________________________________

___________________________________________________________________

_____ Direct marketing

_____ Telemarketing

_____ E-Commerce

_____ Franchising

_____ Other (explain) _____________________________________________

2. What promotional methods does your company use overseas:

_____ Advertising (trade journals, etc.)

_____ Trade Shows (list event and country)____________________________

_________________________________________________________

_____ Direct marketing

_____ Telemarketing

_____ E-Commerce

_____ Franchising

_____ Other (explain)_________________________________________

ASSISTANCE NEEDED

1. What assistance are you seeking from the Commercial Service?

_____ Export training

_____ Development of an international marketing plan

_____ Information on best markets to target

_____ Industry specific market research

_____Other (explain)________________________________________________________

_____ Trade leads

_____ Identification of potential business partners:

_____ Direct buyers

_____ Agents/distributors

_____ Setting-up appointments overseas

_____ Identifying relevant trade shows/events overseas

_____ Background checks on potential business partners

_____ Advocacy (when bidding on government tenders overseas)

3. What questions or export marketing issues would your company like to discuss with an International Trade Specialist?

________________________________________________________________________________

4. Please provide any additional information that your firm believes the Commercial Service

should be aware of to fully understand your company and its requirements.

__________________________________________________________________________________

This collection of information contains Paperwork Reduction Act (PRA) requirements approved by the Office of Management and Budget (OMB). Notwithstanding any other provision of law, no person is required to respond to nor shall any person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the PRA unless that collection of information displays a currently valid OMB Control Number. Public reporting burden for this collection of information is estimated to be 10 minutes 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. Persons wishing to comment on the burden estimate or any aspect of this collection of information, or offer suggestions for reducing this burden, should send their COMMENTS to the ITA Reports Clearance Officer, International Trade Administration, Department of Commerce, Room 4001, 14th and Constitution Avenue, N.W., Washington, D.C. 20230.

________________________________________________________________

Your satisfaction is our top priority. Please inform us of any questions or concerns and we will work quickly and effectively to meet your needs.

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The U.S. Commercial Service Customer Care Hotline is available for you to call toll free Monday through Friday, 9:00 AM to 6:00 PM EST at 1-866-482-8111, or e-mail to [email protected]

We will protect business confidential information to the extent provided under Federal law.

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