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Qualification Application for CCC Export Credit Guarantee Programs

Fields marked with an asterisk (*) are required

Program Applying For:
* Please check all that apply:
  1. Name and Address of Applicant's U.S. Office
    -
    ###-###-####
    ###-###-####
    * Select One:      

  2. Name and Address of Applicant's Headquarters Office (to be completed only if different from above)
    -
    ###-###-#### (if United States)
    ###-###-#### (if United States)


  3. Name and Address of U.S. Agent for the Service of Process (to be completed only if Exporter has no U.S. office)
    -
    ###-###-####
    ###-###-####
    Select One:      

  4. Applicant's Legal Form of Doing Business
    * Type of Business:


  5. U.S. State:


  6. ##-###-####
    ##-#######
     

  7. Certification Statements
    * Please make one of the following certifications:




    * Applicant must certify to the following statement(s) by selecting the block(s) below:


      

    (This form must be submitted by an "officer" of the Company making application.  Please also fax a copy of your Articles of Incorporation to (202) 720-2949.)
     

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0551-0004. The time required to complete this information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.