Form EIB 05-01 EIB 05-01 Marketing Form

OMB # 3048-0029
Expiration Date 11/30/2012

Global Access Forum Response Form

Export-Import Bank of the United States
The Official Export Credit Agency of the Federal Government
Code 6278
Ex-Im Bank has trade finance managers in your region to assist you with your export finance challenges. You may be assured that
all information will be treated as business confidential to the extent provided by federal law. Thank you.
Name: _____________________________________________________________________________________________
Title: ______________________________________________________________________________________________
Company: __________________________________________________________________________________________
Address: ___________________________________________________________________________________________
City: ______________________________________________________________________________________________
State & Zip: _________________________________________________________________________________________
Tel: _______________________________________________________________________________________________
Fax: _______________________________________________________________________________________________
E-mail: _____________________________________________________________________________________________
Web Site: ___________________________________________________________________________________________
Please contact me. I am interested in:
Extending credit to foreign buyers and protecting against nonpayment
Obtaining working capital: ___ under $500,000

____ over $500,000

Enabling foreign buyers to obtain term financing for capital goods and services
My company is a:

Manufacturer

My company is: * Women-Owned

Wholesaler/Distributor
* Minority-Owned

Service Provider
Environment-Focused

* This question is optional. Your answer will have no bearing on the credit decision.
My company has ______ employees (including parent and affiliates).
* We export some goods that have at least 50% U.S. content (i.e., based on product cost, including parts and/or labor).
My company currently exports the following products:
________________________ ________________________
________________________ ________________________
________________________ ________________________
* My company currently exports to the following countries (please list individual countries):
________________________ ________________________
________________________ ________________________
* We provide the following payment terms to our foreign buyers:
Cash in Advance
Open Account: Number of days: _______
Letters of Credit
Credit Card
Other: please specify _____________________________________________
My company’s annual export sales volume is: $ ___________________ (specify thousands or millions)
My company’s primary bank is: __________________________________________
PAPERWORK REDUCTION ACT STATEMENT
We estimate that it will take you about 15 minutes per response that includes the time it will take to read the instructions, gather the necessary
facts and fill out the form. However, you are not required to provide information requested unless a valid OMB control number is displayed on
the form. If you have comments or suggestions regarding the above estimate or ways to simplify this form, forward correspondence to Ex-Im
Bank and the Office of Management and Budget, Paperwork Reduction Project, OMB # 3048-0029 Washington, D.C. 20503.
* Information required

EIB 05-01 05/2012