Form Ita-4093p - Application For An Export Trade Certificate Of Review - U.s. Department Of Commerce Page 4
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4ITEM 9: If the export trade, export trade activities, or methods of operation for which certification is sought will involve any
agreement or any exchange of information among suppliers of the same or similar products or services with respect to
domestic prices, production, sales, or other competitively sensitive business information, specify the nature of and need for the
agreement or exchange of information.
(Attach your response to this application, clearly identifying the attachment as response to ITEM 9.)
ITEM 10: A statement whether the applicant intends or reasonably expects that any exported goods or services covered by the
proposed Certificate will re-enter the United States, either in its original or modified form. If so, identify the goods or services
and the manner in which they may re-enter the United States.
(Attach your response to this application, clearly identifying the attachment as response to ITEM 10.)
ITEM 11: For the goods and services to be exported, provide (if known) the names and addresses of the suppliers (and the goods and
services to be supplied by each) unless the goods and services to be exported are to be supplied by the applicant and/or its
members only.
(Attach your response to this application, clearly identifying the attachment as response to ITEM 11.)
ITEM 12: (Optional) A proposed draft Certificate.
(Attach your response to this application, clearly identifying the attachment as response to ITEM 12.)
ITEM 13: If the applicant is requesting expedited review of its application, specify the facts and circumstances which warrant it in the
space below.
The justification should explain why expedited action is needed, such as bidding deadlines, infrequent shipping service to the point of
destination, or other circumstances beyond the control of the applicant that require the applicant to act in less than 90 days, and that
have significant impact on the applicant’s export trade. The justification should include the dollar value of export sales that would be
lost if an expedited review is not granted.
(If additional space is necessary, attach your response to this application, clearly identifying the attachment as response to ITEM 13.)
CERTIFICATIONS
I certify that the applicant named in ITEM 1 above and each of the members listed in ITEM 2 above has authorized me to submit this
application and the attachments, and to represent the applicant and members, if any, in seeking an Export Trade Certificate of
Review.
TYPED OR PRINTED NAME
SIGNATURE (SIGN IN INK)
DATE
I certify that to the best of my knowledge and belief that the information submitted in this application and the attachments is true and
correct and fully responds to all items in the application.
TYPED OR PRINTED NAME
SIGNATURE (SIGN IN INK)
DATE
FORM ITA 4093-P (REV. 06-05)
USCOMM-DC 85-2 1655
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