Exporting Profile

Customer Profile

So that we can better serve you, please complete the below information as your personal profile

and send to us by clicking on the Submit button at the bottom. We will then contact you as soon

as possible to confirm receipt and to discuss your interests in ExporTrack™ or how we may serve you in obtaining your export licenses. Be assured we protect this information with security procedures and maintain it in the utmost confidentiality for you as our customer.

Personal Info

Full Name: Business Phone:

Job Title: Fax Phone:

Company: Mobile Phone:

Street:

City: State: ZIP:

Country: Province (if applicable): Code:

Above address is mailing address for travel documents? Yes No

E-Mail:

Passport No. Expiration Date: Issued by:

Birthdate: Birth Place: Citizenship:

Select below all the countries that you presently or intend to export to by using Ctrl Key+Left Mouse Button for multiple selects within each box: Southeast Asia /

North/Central America: South America: South Pacific: Western Pacific: Asia:

Middle East: Africa: Europe:

Others Countries:

Please describe the product(s) that you export:

Please provide any questions or general comments you have regarding LodeStar's services and/or products. Please go to http://www.lodestarassoc.com for a description of LodeStar's capabilities.