Form ITA-4139P Application for TRQ License (Form ITA-4139P), Manufactur

ITA-4139P

OMB No: 0625-0240
Expires 06/30/2007

APPLICATION FOR 2007 TRQ LICENSE
MANUFACTURERS OF MEN'S & BOYS WORSTED WOOL SUITS,
SUIT-TYPE JACKETS AND TROUSERS
AVERAGE FIBER DIAMETER GREATER THAN 18.5 MICRONS
Data for January-June 2006
If data provided is to be treated as Busine ss Confidential, please in dicate prom inently across top of fo rm

Company Name:
Company Address:

Company Federal Tax
Identification Number:

_______________________
_______________________
_______________________
_______________________
_______________________

Contact Nam e:
Contact Address:

______________________
______________________
______________________
______________________
Contact Telephone Number: ________________
Contact Fax Number:
________________

Certification Statement: I, the duly authorized representative, as an employee, officer or agent, with personal knowledge of the
matters set out in the application, certify that the information contained therein is complete and accurate, signed and sworn before a
Notary P ublic, and ac knowledg ing that false repr esentations to a federal age ncy may result in c riminal pena lties under fed eral law.
Signature of Representative

Date

Signature of Notary

Date

Please C heck if ga rmen ts are cut an d sewn in your ow n plants
and/or
Please ch eck box if garm ents were c ut and sew n by a co ntractor a nd you had title to the fabric .

Note: Data based on microns.
M& B Worsted W ool Suits
of 85% or More by Weight
Wool

M& B Wo rsted Wo ol SuitType Jackets of 85% or More
by Weight Wool

M&B W orsted Wool
Trousers of 85% or More by
Weight Wool

Greater than 18.5 Micro ns
Quantity and Value
Period

Units

($)

Units

January-June 2006

($)

January-June 2006

Units

($)

January-June 2006

Produc tion (fob pla nt)
Using T RQ Fa bric
Using N on-TR Q Fabr ic
Names a nd Add ress of Plants
producing
Contractors and Location of
Plants
For listing additional plants and/or contractors, go to the next page.
Public reporting for this collection of information is estimated to average 3 hours per response, including the time for reviewing instructions, and completing and
reviewing the collect ion of informat ion. All responses t o this collectio n of informati on are voluntary, a nd will be provided confidentia lity to the extent a llowed under
the Freedom of Information Act. Not withstanding any other provision of the 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 the 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, DC 20230.

Continued on Next Page

ITA-4139P

OMB No: 0625-0240
Expires 06/30/2007

Continuation Sheet APPLICATION FOR 2007 TRQ LICENSE

Purchases of
Quantity and Value

Period

Worsted W ool Fabric of
85% or More by Weight
Wool For M &B Suits

Worsted Wool Fabric of
85% or More by Weight
Wool For M&B Suit-Type

Greater than 18.5 Micro ns

Greater than 18.5 Microns

Square
Meters

($)

January-June 2006

Square
Meters

($)

January-June 2006

Worsted Wool Fabric of
85% or More by Weight
Wool For M& B Trousers
Greater than 18.5 Microns
Square
Meters

($)

January-June 2006

Dome stic (fob plant)
Imports (v alue = c.i.f.)
TRQ Imports
Non-T RQ Imp orts
List Additional Plants Below

M&B W orsted Wool Suits of
85% or More by Weight
Wool

M& B Wo rsted Wo ol SuitType Jackets of 85% or More
by Weight Wool

M&B Worsted Wool Trousers
of 85% or More by Weight
Wool

Greater than 18.5 Micro ns
Names and Address of
Plants producing
Names and Address of
Plants producing
Names and Address of
Plants producing
List Additional Contractors Below
M&B W orsted Wool Suits of
85% or More by Weight
Wool

M& B Wo rsted Wo ol SuitType Jackets of 85% or More
by Weight Wool

M&B W orsted Wool
Trousers of 85% or More by
Weight Wool

Greater than 18.5 Micro ns
Contractors and Locations
of Plants
Contractors and Locations
of Plants
Contractors and Locations
of Plants
If additional sp ace for listing pla nts and/or co ntractors is nee ded, use this p age again afte r printing or atta ch a blank sh eet of pape r with
the requested information.
Ma il complete d, notarized form to: Industry Assessment Division, Office of Textiles and Apparel, Room 3100, U.S. Department
of Commerce, 1401 Constitution Ave., NW, Washington, DC 20230