Name / Title:

Company or Organization:

Address Line 1:

Address Line 2:

Telephone:

E-Mail:

Does your company import product? Yes No

If yes, what is the approximate annual dollar value of imported material?

Does your company export product? Yes No

Are your imports restricted in any manner (i.e. quota/visa)? Yes No

Has you company reviewed FTZ benefits in the past? Yes No

Please briefly describe your company’s operations including the type of merchandise imported and/or exported and the activities conducted at your facility.