Legal Title*公司注册名

Business Title** 公司发票上名

Address*** 1. Line公司总部地址

Address 2. Line地址

Address 3. Line地址

City城市

State/Province/Region省/地区

ZIP邮编

Country国家

Phone Number

Fax Number传真

URL网址

E-mail电邮

Tax Authority 税务注册机构

Tax Registry Number税务登记证号

Number of Employee员工数（平均工龄）(Yearly average)

Total Sales in USD (last year)去年销售额

Year of Establishment建立时间

Legal (Corporate) Status现状

International certificates owned and their registry numbers

国际质量认证证书及其编号

Countries products are exported to

  Export country(ies)

  Product(s)

出口目的地

产品

I hereby declare that the information presented above is correct and verifiable.

Name, surname and title in the company 姓名及在公司职务

Company stamp and sing of the authorized person 公章及负责人签字