Massachusetts Export Center

Export Growth Initiative

Statement of Confidentiality
We strongly respect the privacy of our clients. The information collected through this application will be kept strictly confidential.

Contact Information

Mr. Ms.

First Name:

Last Name:

Title:

Company:

Address:

City:

State:

Zip Code:

Telephone:

Fax:

Email:

Website:

Company Information

Year Established:

Number of Massachusetts employees:

Annual Sales:

Product Description:

Does Your Company Currently Export? Yes No

If yes, where?
Annual export sales:

Do you have an export development budget? Yes No

If yes, how much?
If no, how much are you willing to budget?

What are your export goals?

If exporting, do you have an export compliance program? Yes No

Will you be willing to travel overseas for follow-up purposes? Yes No

	I agree that by submitting this application, I will complete a confidential impact survey following the conclusion of this program. I also grant permission to the Massachusetts Export Center to notify my elected legislator(s) that they have provided assistance to my firm. I understand that confidential details on my firm will not be divulged.