![](media/image1.wmf){width="1.25in"
height="0.7493055555555556in"}Welcome to the Central PA BuyUSA.gov

Business Service Provider Directory

#### A Service of the Harrisburg U.S. Export Assistance Center 

Information and Payment Form

Please be sure to read and complete carefully

The goal of the *Central Pennsylvania BuyUSA.gov Business Service
Provider Directory* is to provide an additional resource to the U.S.
exporting client-base in the Central Pennsylvania area. This directory
contains information on various services that many small- and
medium-sized exporters require, both here in the United States, as well
as internationally.

The *Central Pennsylvania BuyUSA.gov Business Service Provider* lists
are not comprehensive, and inclusion does not constitute an endorsement
or recommendation by the U.S. Commercial Service, and we assume no
responsibility for the professional ability or integrity of the
organizations whose names appear in the Business Service Provider
directory.

**Qualifications for Business Service Provider Listings (BSPs):**

1.  BSPs must provide a direct service to U.S. exporters for their
    international transactions and endeavors.

2.  Complete application and payment forms.

3.  Must provide proof of legitimacy, including references (see
    application)

**Business Service Provider Application Checklist**:

-   Complete application on-line at:
    <http://www.buyusa.gov/harrisburg/application.html>

-   Complete payment form and fax to (717)-871-2132.

-   Send company logo (jpg file) to <deborah.doherty@mail.doc.gov>

> (File must be no larger than [200 pixels wide]{.underline} for
> upload).

-   Sign and FAX completed Participation Agreement (you will receive
    this via email after your application and payment is submitted).

Business Service Provider Payment Form

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(Company
name) agrees to pay \$250 for one page, plus company logo and link to
company website to appear on the U.S. Commercial Service, Harrisburg
website for one year
([**http://www.buyusa.gov/harrisburg**](http://www.buyusa.gov/harrisburg)).
The promotion will appear in the section under Business Service
Providers, which pertains to services for U.S. exporting companies.

**PAYMENT FOR: [Central Pennsylvania BuyUSA.gov Business Service
Provider Directory]{.underline}**

**NAME ON CARD:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**ADDRESS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**CITY \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_STATE
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ZIP \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**CARD TYPE:\
\
\_\_\_\_\_\_\_ American Express \_\_\_\_\_\_\_\_ Master Card
\_\_\_\_\_\_\_\_\_ VISA**

**ACCOUNT NO.:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**EXPIRATION DATE (month - year):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**COMPANY'S NAME
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**TELEPHONE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
FAX: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**E-MAIL ADDRESS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

Complete and submit this form (via FAX or email) and company logo (via
email) to:

### FAX: (717) 871-2132

# Email: <deborah.doherty@mail.doc.gov>