Distributors List Registration Form

FAS Export Directory
of U.S. Food Distribution Companies
Registration Form

The mission of the Foreign Agricultural Service (FAS) is to promote exports of U.S. food, farm,
seafood, fishery and forestry products. One of the ways this is accomplished is with the
Export Directory of U.S. Food Distribution Companies. The list provides the names of qualified
U.S. exporters that have the capacity to provide mixed containers of grocery products directly to
a foreign buyer. The Export Directory of U.S. Food Distribution Companies can be found on-line
at http://usdistributors.agexportservices.org/Apps/StoreFronts/search.asp.

Please provide the following information on your company to register to be included in
the Export Directory of U.S. Food Distribution Companies:
Company Contact Information:
Company name:

______________________________________________________

______

Secondary company name: ________________________________________________

_____

Street address: ________________________________________________________ _

____

City: ______________________________ State:_________________ Zip code: _____

_____

Phone: _______________________________ Fax Number: ________________ _

________

Contact Name: ____________________________ Title: ________________________________
E-mail Address: ________________________________________________________________
Website Address:_______________________________________________________________
Year founded: __________ Sales Volume: _____________ Number of Employees:__________

Company Business/Export Services -- Please check below those that apply:
Export Management
Product Representation
Broker Services

Consolidation
Freight Forward and Distribution Services
Manufactures/Distributes Own Branded Label

What regions of the world are you currently exporting to? Please check those below that
apply:
All Regions
Africa (Sub-Saharan)
Africa (North)
Australia and Oceania
Canada
Central America (excluding Mexico)
China
Eastern Europe and Russia

India
Mexico
Middle East
Northeast Asia (excluding China)
South America
Southeast Asia (excluding India)
The Caribbean
Western Europe

What products are you currently exporting? Please check those below that apply:
Beverages
Condiments
Consumer Ready
Dairy Products and Eggs
Fish and Seafood Products
Frozen Products
Fruit Products
Grocery Products

Ingredients
Meat and Poultry Products
Pasta and Bakery Products
Perishables
Snack Foods
Specialty Foods
Vegetable Products

Please check those below that apply to any of your exported product lines:
Certified Organic
Natural Foods (Not Certified Organic)
Kosher

Halal
Food Service
Does Not Apply

Additional Questions:
YES
Do you provide private labeling?
Do you provide local language labeling?
Do you provide pack date/expiration labeling?
Do you offer product reformulation?
Do you offer financing?
Do you have available:
Pet food
Non-food grocery items (i.e. plastic wrap, paper products)
Alcoholic beverages (Wine, beer, spirits)
Do you carry National Brands? If yes, please list:

NO

Additional information/comments/questions:

Thank you.

Please submit this completed form to Anne Almond via e-mail to [email protected]
or fax to (202) 690-0193.

According to the Paperwork Act of 1995, an agency may not conduct or sponsor and a person is not required to respond to, a collection of information
unless it displays a valid OMB control number. The valid OMB number for this information collection is 0551-0031. The time required to complete this
information collection is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering & maintaining data needed for completing & reviewing the collection of information
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, sex,
religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with
disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET
Center at (202) 720-2600 (voice and TDD).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 14th and Independence Avenue, SW,
Washington DC 20250-9410 or call (202) 720-5964 (voice and TDD). USDA is an equal opportunity provider and employer

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March 2012, OMB 0551-0031