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Tell Us About You

Our staff prepares to assist export ready companies by assessing the firm's current interest and needs, previous international experience and organizational/product capabilities. This survey, which precedes the initial consultation, is the first step in this process. Please complete the following survey, submit it, and a trade specialist will contact you after reviewing the information provided.

Fields marked with * are required.
OMB Control No.: 0625-0237
Expiration Date: 10/31/15
    Contact Information
Contact First Name:*  
Contact Last Name:*  
Title within Organization:*  
Email Address:*    Receive a Copy
Daytime Phone Number:  
Fax Number:  
Mobile Number:  
    Organization Information
Organization Type:  

Educational Institution
Service Provider
Organization Name:*  
Organization Address 1:*  
Organization Address 2:  
Organization City:*  
Organization State:  
Organization Country:*  
Organization Zip Code:  
Organization Web Site*:  
Number of employees in Business*:  
Estimated Annual Sales:  
Less than $500,000
$1 Million to $2.5 Million
$5 Million to $7.5 Million
$10 Million to $25 Million
$50 Million to $100 Million
More than $250 Million
$500,000 to $1 Million
$2.5 Million to $5 Million
$7.5 Million to $10 Million
$25 Million to $50 Million
$100 Million to $250 Million
*Select Your Industry:  
Countries Your Business is currently Exporting to (select up to 5):  
Year Organization Was Established:
Company Profile
Sales Method:*  
Joint Venture

*If you are not a manufacturer, do you or your firm have documented right to export the product or service?*
Yes    No    Not applicable  

*Is your product/service at least 51% U.S. content?
Yes    No  

Estimated Percentage of Annual Sales Derived from Exporting:

Do you have an export promotional budget?
Yes    No  

Company Background*

Product/Service Information
Product/Service name

Please describe your product/service:

Please describe the primary users of your product/service:
Market Information
Your immediate international objectives:

Countries you are currently exporting to:

Countries you would like to target in the next 12-18 months:

Have you proactively exported in the last 12 months?*
Yes  No
Your Local U.S. Department of Commerce Office
Are you currently working with one of our offices/U.S. Export Assistance Centers in the United States?*
Yes    No  

Trade Specialist or Office*
If yes, please select the International Trade Specialist with whom you are now working with.

Other Trade Specialist or Office
If known, feel free to add the name of your trade specialist if not listed above

The Irvine USEAC has partnerships with local export promotion organizations to help us provide a full range of export counseling. Please indicate if we can share the information you are submitting in this form with our local partners such as the Small Business Development Centers of the SBA (SBDC)?
Yes    No

In the past 24 months, have you or your company utilized any market research reports or trade promotion programs, or received counseling from the U.S. Dept of Commerce or one of its U.S. Export Assistance Centers?*
Yes    No  

If yes, has the program of information provided assisted you in completing your export sales?
Yes    No  

If time allows, could you please explain?
Where did you hear about the U.S. Commercial Service?
Trade seminar/conference/event
Federal Government agency
Local Government agency
Local school/university presentation
Non-profit trade organization
Internet research
Which specific event or organization?



Public reporting for this collection of information is estimated to be 5 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. 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 Paperwork Reduction Act unless that collection of information displays a currently 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, D.C. 20230.