Please fill out this form for membership. Information will be kept strictly confidential and used for our data bank.

    Name of Company:

    Name of Designated Representative:

    Designation of the Representative

    Adress of the Company:
    Post Box No:

    Telephone:

    Telex No:

    Fax No:

    Business relation with USA:
    (Type of business/name and address of business associate/s in the USA)
    Branches / Factory/ Overseas Office
    Address:

    City

    P.O. Box:

    Telex:

    Phone:

    Email:

    Fax:

    Estiblished as:
    ManufactureImporterAgentDistributorRetailerExporterService IndustryIntendorWholesalerOther

    Legal Status:
    ProprietorshipPvt. Ltd. CompanyCooperativePartnershipPublic Limited Co.Other
    Parent Company (If applicable)

    Subsidiary/ies, if any

    Manufacturing License agreement, if any

    Capital Paid Up (In Rs):

    Establishment Year:

    Is your products are available for export(if applicable)
    YesNo

    If answer is yes, please specify product type, quantity available

    Available of sales Aids/Promotional/Publicity Materials

    If yes, please describe

    Nature of business dealing in USA, please describe

    Give name and address of business associate in the USA

    Any other relevant information

    Person Submitting the above information
    Name

    Capacity

    Date

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