IDENTITY

Company Name
Address
 
 
City
State             Zip
Contact Information
First Name Last Name
Title
Phone Fax
Email Website
Description of export business activity:

OWNERSHIP

Structure: C Corp S Corp LLC Partnership Sole Owner Co-op

Ownership: Privately-held Publicly-traded

If privately-held, total number of owners:

Do you have any individual or corporate foreign shareholders? Yes No

If yes, how many? Percent of ownership for each:

Are the members of this owners’ group currently operating or have in existence an

Interest Charge Domestic International Sales Corporation (IC-DISC)? Yes No

VALUES

Date of Fiscal Year-End:

Full Fiscal Year Export Sales (QER): $

Full Fiscal Year Export Sales Cost of Goods Sold (COGS): $

Full Fiscal Year Export-Related Expenses (SG&A): $