Company Questionnaire Form

U S COMMERCIAL SERVICE

COMPANY QUESTIONNAIRE

OMB Control No. 0625-0143

Expiration Date: xx/xx/xxxx

Please indicate the service you are interested in:

Gold Key Service International Partner Search

Please indicate the country/countries of interest:

A. Contact Information

Company Name:      
Address:      
City:      	Zip Code:      
Company Web Site:      
Contact Person:      	Title:      
Contact Tel:      	Contact Fax:      
Contact E-mail:      
Alternate Contact:      	Title:      
Alternate Contact E-mail:      	Alternate Contact Tel:      

B. Company Information

Company Activity: (Please select all that apply) Manufacturer Distributor/Representative Export Management Company	Service Company Franchiser Other (please specify):
Number of Employees (est.):
Annual Sales: Less than $5 Million $5-10 Million More than $10 Million
Annual Exports (as % of Total Sales): Less than 25% More than 25%
Brief Company Description:
Are you currently working with a U.S. Export Assistance Center (USEAC)? Yes No
If yes, please provide City and Trade Specialist name:      

C. Product/Service Information

Does your product contain at least 51% U.S. content? Yes No
Describe the product/service(s) you seek to promote including its competitive advantages and unique selling proposition. Include its applications and unique features that differentiate your product from that of the competition.      
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 United States (and in other countries if applicable)?           
What type of licensing or registration does it require in the U.S.? (i.e. FDA approval)           
What related products might a representative/partner of this product/service also handle?            
Does your company produce or have rights to export the product/service? Yes No
HS Code (optional):
Export Control Classification Code (optional):

D. Business Objectives

What type of business contacts are you seeking? Distributor / Wholesaler Agent / Sales Representative Franchisee	Joint Venture Partner or Licensee Other (please specify)
Is your firm seeking representation on an exclusive basis in this market? Yes No
Describe any preferences, technical qualifications, servicing capabilities, requirements, or pre-qualifications that ideal prospects must have, such as English language ability, size, coverage, investment etc.            
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.           

F. LOCAL PARTNER INFORMATION (If Applicable)

Is your company currently represented in this country/region? Yes No
If yes, is this arrangement exclusive? Yes No
If applicable, please provide the necessary contact information of your current representative/partner:
Company Name:      
Address:
Contact Person:      	Title:      
Contact Tel:      	Contact Fax:      
Contact E-mail:      
Is your representative/partner aware you are seeking additional representation? Yes No

F. LOGISTICAL Information (Gold Key Service Only)

Desired Dates for Service:      	Alternative Dates:      
Desired Locations:            
Additional Services: (please note any other assistance that would be required)

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.