+---------------------------------------------+------------------------+
| ##                                          | ![](me                 |
|                                             | dia/image1.wmf){width= |
| ## Gold Key Service Slovenia                | "1.4902777777777778in" |
|                                             | height="1.86875in"}    |
| # Application Questionnaire                 |                        |
|                                             |                        |
| ### Embassy of the United States of America |                        |
|                                             |                        |
| Presernova 31, 1000 Ljubljana               |                        |
|                                             |                        |
| Tel. + 386 1 200 55 28, Fax: + 386 1 200 55 |                        |
| 29                                          |                        |
|                                             |                        |
| Email: spela.zlatnar@mail.doc.gov           |                        |
|                                             |                        |
| Web: [www.buyusa.gov/slovenia]{.underline}  |                        |
+---------------------------------------------+------------------------+

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  **YOUR COMPANY INFORMATION**

  Name of your company

  Company address

  City, state, zip

  Name of company representative(s) planning to visit

  Telephone Fax

  Email

  Website URL

  Type of business activity

  Number of employees

  Year established

  Approximate annual sales
  -----------------------------------------------------------------------

  -----------------------------------------------------------------------
  **CHARACTERISTICS OF TARGETED SLOVENE PARTNER**

  Minimum size (employees, turnover, etc.)

  Industry/business activity

  Are there specific companies you would like us to contact or companies
  you would like us to avoid?
  -----------------------------------------------------------------------

  -----------------------------------------------------------------------
  **PRODUCT INFORMATION**

  Product description (for exports from the U.S.)

  Do you anticipate any special product requirements (e.g., licensing,
  registration, etc.)?
  -----------------------------------------------------------------------

  -----------------------------------------------------------------------
  **ADDITIONAL INFORMATION**

  Is your company represented in Slovenia? If your company is not
  represented now, has it ever been?

  If yes, please explain briefly - how should the former/current
  distributor be handled?

  How did your company learn about our gold key service?
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  -----------------------------------------------------------------------
  **YOUR PLANNED VISIT**

  Dates of planned visit

  Address in Slovenia (if known)

  Telephone and fax in Slovenia (if known)

  Objective of visit
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+--------------------------+-------------------------+----------------+
| ##                       |                         |                |
| ## ADDITIONAL SERVICES\* |                         |                |
+--------------------------+-------------------------+----------------+
| ##### Service            | **Details**             | **Maximum      |
|                          |                         | total cost**   |
+--------------------------+-------------------------+----------------+
| Hotel accommodation      | Type and \# of rooms:   |                |
+--------------------------+-------------------------+----------------+
| Interpretation           | Languages:              |                |
+--------------------------+-------------------------+----------------+
| Car and driver           | \# of passengers:       |                |
+--------------------------+-------------------------+----------------+
| Rental car               | Type and size:          |                |
+--------------------------+-------------------------+----------------+
| Office space/services    | \# of computers needed, |                |
|                          | special requests:       |                |
+--------------------------+-------------------------+----------------+
| Advertising --           |                         |                |
| *especially franchising  |                         |                |
| companies are            |                         |                |
| recommended to           |                         |                |
| advertise*               |                         |                |
+--------------------------+-------------------------+----------------+

\*Additional services are arranged by the Embassy but are paid by the
applicant company.

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  -----------------------------------------------------------------------

Please contact me to confirm the dates of my Gold Key Service! I am
aware of the terms and conditions of participation as they appear below.
Once the dates have been confirmed, you will receive a minimum of 20
packages of product-descriptive literature at least five weeks before
the agreed date (as appropriate).

-   Please charge \$\_\_\_\_\_\_\_\_ to my credit card (American
    Express, Discover, MasterCard, Visa):

Name of signing party: [.]{.underline}

Type of card (Visa, Mastercard, etc.): [.]{.underline}

Card number: [.]{.underline}

Expiration date: [.]{.underline}

I am interested in additional Gold Key service in the following
countries:

+-----------------------------------+-----------------------------------+
| -   Austria                       | -   Romania                       |
+-----------------------------------+-----------------------------------+
| -   Croatia                       | -   Latvia                        |
+-----------------------------------+-----------------------------------+
| -   Czech Republic                | -   Poland                        |
+-----------------------------------+-----------------------------------+
| -   Germany                       | -   Bulgaria                      |
+-----------------------------------+-----------------------------------+
| -   Italy                         | -   Estonia                       |
+-----------------------------------+-----------------------------------+
| -   Slovak Republic               | -   Lithuania                     |
+-----------------------------------+-----------------------------------+
| -   Switzerland                   | -   Other :                       |
+-----------------------------------+-----------------------------------+

Date Signature

+-----------------------------------------------------------------------+
| **TERMS AND CONDITIONS**                                              |
+-----------------------------------------------------------------------+
| The Gold Key Service is designed for U.S. business visitors who would |
| like to meet personally with potential Slovene wholesalers,           |
| distributors, licensees, or end-users. Our office assists by          |
| contacting the most qualified Slovene firms, providing them with      |
| product information (such as brochures and price lists) that you      |
| supply, and arranging a maximum of 6 appointments per day with        |
| qualified firms. Included is also a thorough market briefing by an    |
| industry specialist from our office. The following terms and          |
| conditions apply:                                                     |
|                                                                       |
| Fee for one-day visit: \$735                                          |
|                                                                       |
| Additional days: \$400 per each additional day                        |
|                                                                       |
| Credit Card payment: Visa, MasterCard, AmEx, Discover                 |
|                                                                       |
| Prepayment: full                                                      |
|                                                                       |
| Advance notice required: 4 weeks                                      |
|                                                                       |
| Additional services: Office space, including telephone, PC,           |
| photocopier, etc. can be provided upon payment of additional fees.    |
| Our office can also arrange for interpretation, transportation, and   |
| accommodation with local providers. All costs for these additional    |
| services are carried by the applicant.                                |
|                                                                       |
| The Gold Key Service is initiated on the receipt of payment and only  |
| after confirmation of a reasonable market potential for your          |
| product/service and approval of the proposed dates by the US Embassy  |
| Ljubljana. All information contained in this questionnaire and in     |
| follow-up reports will remain confidential unless otherwise directed  |
| by you.                                                               |
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