This page requires JavaScript to function properly.

You should set the preferences, options, or security of your browser to enable JavaScript.  Then refresh or reload this page.
FAS Online Logo Return to the FAS Home page
FAS Online Logo (cont.) Help Icon Help

OMB Number 0551-0037

Qualification Application for CCC Export Guarantee
and Subsidy Programs

  Fields marked with an asterisk (*) are required

Program Applying For:
* Please check all that apply:
  1. Name and Address of Applicant's Headquarters Office:
    -
    ###-###-#### (if United States)
    ###-###-#### (if United States)
    * Please check that which applies:
                   

  2. Name and Address of Applicant's U.S. Office:
    (only to be completed if different from above)

    -
    ###-###-####
    ###-###-####
    Select One:      

  3. Name and Address of U.S. Agent for the Service of Process:
    (only to be completed 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 by selecting the block:


      
    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 0551-0037. The time required to complete this information collection is estimated to average 36 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.

[cccapp/FoodAid/FFP/images/footer.html]