Application-start – Trade Adjustment Assistance Center (TAAC)

Year Founded
Year Incorporated
Type(s) of business that firm is engaged?
Descriptions of goods and services produced & sold?
Firm Type:
- Manufacturing
- Service
Legal form of organization
- Proprietorship
- Partnership
- Joint Venture
- Association
- Corporation
- Other
Enter All NAICS Codes:
NAICS code: *5 digits
NAICS code: *5 digits
NAICS code: *5 digits
NAICS code: *5 digits
NAICS code: *5 digits
Enter All HTS Codes:
HTS code: *9 digits
HTS code: *9 digits
HTS code: *9 digits
HTS code: *9 digits
HTS code: *9 digits
Duns number: *9 digits
Congressional district: *2 digits
County:
Location and nature of business of all manufacturing, production, distribution and sales facilities, both domestic and foreign:
Market(s) served by firm (aerospace, mining, steel, etc.):
Names and titles of officers, directors, and managers and their percentage of ownership or ownership interest of the firm: *allow up to 10 entries*
!!!----DONT COPYSignificant ownership or management changes in the last five years:
Any other important events in the recent history of the firm, such as natural disasters, fires, labor strikes, changes in product line, bankruptcy, etc.:

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Articles Produced Affected by Imports
List the articles produced by your firm that are adversely affected by import competition
Provide a brief description of your product’s manufacturing process and the principal materials involved:
Does your firm purchase articles for resale?
- Yes
- No
If yes, describe articles being resold:
Provide a brief statement on the effect import competition has had on your firm. Please include as much detail unique to your firm as possible:
Does your firm have export sales about 5%?
- Yes
- No

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Related Firms:
Does the petitioning firm (or its owners) have any significant ownership interest in other companies?
- Yes
- No
If no, you do not need to complete this section.
If yes, please provide the following information for any subsidiary or any other related firm:
Related firm name:
Related Firm Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is business active?
- Yes
- No
If No, inactive date:
Business Type:
Products/Services sold:
Dollar amount of intercompany transactions:
Explain relationship between firms (subsidiary, parent, affiliate, division, other please explain):
Nature of business (i.e. Supplier, holding co., lease property, etc.):
------------------------------Number
Please enter a value between 4 and 20.
Are there additional related firms?
- Yes
- No
Related firm name:
Related Firm Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is business active?
- Yes
- No
If No, inactive date:
Business Type:
Products/Services sold:
Explain relationship between firms (subsidiary, parent, affiliate, division, other please explain):
Nature of business (i.e. Supplier, holding co., lease property, etc.):
Dollar amount of intercompany transactions:
Dollar amount of intercompany transactions:
Customer list
Identify 4-6 United States customers that have switched to foreign-produced products rather than purchasing from you during the petitioning period. If you cannot provide customers, please contact the TAAC at (607)777-2040.
Customer Name
First Last
Contact Person
First Last
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Company Info
Company Name:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name
First Last
Phone
Ext
Products Purchased:
Sales
Customer sales listed below:
Start Date:
End Date:
$
Please provide the sales data for those customers during the petition lookback period per instructions provided by TAAC email:
Prior Sales:
Current Sales

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Upload Documents
Please provide copies of the following documents per email instructions provided by TAAC:
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1. Balance Sheets
2. Profit & Loss Statements: Monthly Consolidated Statements
3. Employment Records for your state or if necessary, third party payroll reports:
• New York State Clients: NYS45
• New York State Clients: NJ92
• Puerto Rico Clients: Contact for additional instructions
File
File
File
File
File

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Application Start

Step 1 of 5

Articles Produced Affected by Imports

Related Firms:

If yes, please provide the following information for any subsidiary or any other related firm:

Customer list

Company Info

Sales

Customer sales listed below:

Please provide the sales data for those customers during the petition lookback period per instructions provided by TAAC email:

Upload Documents

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(Previously uploaded files if any list here)