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ANEXO Nº 6
REGISTRATION FORM FOR INTERNATIONAL BUYERS
I.
EVENT INFORMATION (To be filled out by PROMPERÚ)
1.1. Event
Centro Exporta 2017
1.2. Place and date
Huanuco
City
Country
Peru
Start date
05
2017
03
04
Finish date
05
2017
II. COMPANY INFORMATION
2.1.
2.2.
2.3.
2.4.
2.6.
Company name
Trade name
Phone(s)
Address
City
2.5. Postal Code
2.7. Country
2.8. Website
2.9. Fax
III. CONTACT INFORMATION AND REPRESENTATIVES
3.1. Contact name (person who work as the coordinator or focal point of information concerning an event)
Full name
Type and number of ID
Document
Position at the Company
E-mail
Phone
E-mail
Phone
( ) Passport: _______________________
( ) Alien registration card: ____________
( ) Passport: _______________________
( ) Alien registration card: ____________
3.2. Representatives (person who will attend the event)
Full name
Type and number of ID
Document
Position at the Company
( ) Passport: ______________________
( ) Alien registration card: ___________
( ) Passport: ______________________
( ) Alien registration card: ____________
IV. COMPANY PROFILE (Mark with an X)
4.1. Date of Establishment
4.3. Annual sales (USD)
4.2. Number of employees
4.4. Annual imports (USD)
(Last year)
4.5. Type of business
4.6. Company industry
(Last year)
(
(
(
(
(
)
)
)
)
)
Importer
Distributor
Supermarket
Retailer
Agribusiness
(
(
(
(
(
( ) Miscellaneous manufacturing
)
)
)
)
)
Manufacturer / Producer
Broker (Sales Agent)
Wholesaler
Others (Specify): ________________________
Fishery products
( ) Services
Apparel and home decor (Including
( )
( ) Others (Specify): ________________________
giftware)
Product description
Product information
Certifications
(Biotrade, fairtrade, etc.)
4.7. Products you offer
(Add as many rows as necessary)
4.8. Geographic scope
( )
City
( ) Domestic
( ) Regional
( ) International
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V. INFORMATION FOR YOUR PARTICIPATION AT THE EVENT (Mark with an X)
(If your company wants to buy Services, you must complete the Appendix A also)
5.1. Is it your first time at this
event?
( ) Yes
( ) No,
If not, please tell us:
5.2. Have you tried to buy
goods or services from
the Peruvian market
before?
5.3. Indicate goods / services
you bought
( ) Yes
( ) No,
If so, please tell us how:
How did you get in contact with Peruvian companies?
( ) Business trip ( ) Market research ( ) Internet ( ) Others (Specify): ___________________
How many times have you participated in events with PROMPERÚ: ____________________
(Please detail)
Product description
Product information
5.4. Indicate which products
you are interested in
purchasing (Please detail)
Certifications
(Biotrade, fairtrade, etc.)
(Add as rows as necessary)
5.5. Are you interested in
meeting with some
specific company?
( ) Yes
( ) No
Company name
If so, please complete below:
Contact person
Phone
E-mail
VI. ADDITIONAL INFORMATION (Mark with an X)
6.1. How did you hear about
this event?
( ) PROMPERU
( ) Peru Trade Office at ______________________________
( ) Others (Specify): _____________________________
VII. IMPORTANT NOTICE

PROMPERU will notify the evaluation results to the email address from number 3.1. If your company is admitted, you will receive
attached to this notification, the business agenda or visit agenda.
Participant obligations
 Attend business meetings in the date and time scheduled.
 Provide Buyers Survey properly filled out after the event, if required.
Stamp and legally binding signature
Date: _____/_____/_____
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VIII. COMPANY EVALUATION (For PROMPERÚ use ONLY)
8.1. Do you agree proceeding
( ) Yes ( ) No
with the registration?
8.3. What were the reasons for choosing this potential buyer?
a)
8.2. Evaluation date:
/
/
b)
c)
8.4. Comments:
Evaluated by:
Approved by:
Signature
Signature
Full name: __________________________________
Full name: _________________________________
Position at the company: _____________________________
Position at the company: ____________________________
Date: _____ /_____ /______
Date: _____ /_____ /______
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