Export.Gov Account Info (OMB No.: 0625-0237 Expire: 04/30/2012)

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Login Information
* Login Name:            
* Password:            

Passwords must be at least 6 characters long, contain alpha numeric characters.

* Confirm Password:            
Contact Information
* Account Type:            
*Business Name:             
* Business Address Line 1:            
Business AddressLine 2:            
* Business City:            
Business State:            
*Business ZipCode:            
* Business Country:            
* Mr./Ms./Dr./:            
* Contact First Name:            
Contact Middle Initial:            
* Contact Last Name:            
Title within company:            
Contact Suffix:            
* Daytime Phone:            
Fax Number:            
* Email Address:            

Company Information
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Company Web Site:            
* Business Types:            
Number Of Employees:            
Product Description:            
(Max. Of 500 Characters)         
Estimated Annual Sales:            
* Industry:            
* Countries of Interest:            

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This report is authorized by law (15 U.S.C. 1512 et seq., 15 U.S.C. 171 et seq.). Public reporting for this collection of information is estimated to average 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 confidentiality to the extent allowed under the Freedom of Information Act. 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. OMB No. 0625-0237; Expires: 04/30/2012