WEST VIRGINIA STEP - Client Registration Application

STEP Client Registration

Instructions
Please try to answer every question on this application. You will have the opportunity to clarify or add special notes at the bottom of this form. If you have any questions, please contact:

Enybe Diaz
West Virginia STEP Director
Enybe.Diaz@wv.gov
304-352-3957

Caitlin Ashley-Lizarraga
Manager, International Trade
Caitlin.Lizarraga@wv.gov
304-558-2234

Company Information

Company Name (as registered with the WV Secretary of State)* *

Does your company use a DBA? If so, please list below. *

Brief company description:

Describe the product/service(s) to be promoted.

Is your company headquartered in WV?

Yes No

Company Address

County

If you are not headquartered in WV please list headquarters name, address, and website:

Has your business ever used STEP funding from another state?

Yes No

Businesses may not receive STEP funding from different states for the same funding period. For funding period October 1, 2020- September 29, 2022, do you agree to only access the STEP funding through the State of West Virginia?

Yes No

Company Website

D&B D-U-N-S Number (if your company has one)

NAICS Number

Click here for additional information on NAICS.

Harmonized Tariff Schedule (HTS) Number or Schedule B Number (9 digits)

Click here to find your HTS Number

Industry Sectors (Check all that apply):

Activity(ies) (Check all that apply):

Manufacturer Distributor/Representative Export Management Company Service Company Franchiser Educational Institution

What year was your company established?

Do any of the following designations describe the ownership of your company?

Woman-owned Minority owned Veteran or service-disabled veteran owned Rural

Number of employees:

Is your company licensed to do business in WV?

Yes No

Is your company organized for profit?

Yes No

Does your company have a finished product or qualifying service with at least 51% U.S. content?

Yes No

Is your company in good standing with the West Virginia State Department of Tax and Revenue?

Yes No

Does your company agree to complete one post-event survey, and one program closeout survey during the first year, and a yearly performance survey for the next two years?

Yes No

Eligibility Forms

Applicants must self-represent as an Eligible Small Business Concern in order to be considered eligible for STEP funding. Select the link below to complete the self-representation form.

Self-Representation as an Eligible Small Business Concern Form

Upload your completed and signed certification by clicking below.

Choose file

Applicants must not be barred from receiving federal funds to be eligible for STEP Program.

Certification Regarding Debarment, Suspension, and Other Responsibility Matters

Upload your completed and signed certification by clicking below.

Choose file

STEP Payment

In order to receive funding under the West Virginia STEP Program, your company must be registered as a vendor with the State of West Virginia. If your company is not a registered vendor, a representative from the STEP program will reach out to you to become one.

Is your company a registered vendor?

Yes No

Export Information

My objective is: *

To start exporting (No export experience, “accidental” or “occasional” exporter, or have not exported in more than 24 months) Market expansion (currently exporting to one or more markets, expanding into a new country market or expanding into a new region, or new population target segment, or new product line within an existing market)

If you are currently exporting, for how long?

What countries have you exported to?

Average Annual Sales:

Less than $5M $5-10M More than $10M

Annual Exports (as % Total Sales):

Less than 25% More than 25%

What are your countries of interest for export?

What trade shows in foreign countries would you like to participate as an exhibitor? Please provide name of trade show and country of location.

Export Concerns and Training Needs (Check all that apply):

Market Knowledge Duties / Tariffs Legal Considerations Export Compliance Shipping / Logistics Regulations / Certifications Export Financing Methods of Payment

Any additional details:

By electronically signing below, you certify that the information on this application is correct and that you agree to adhere to all of the West Virginia STEP guidelines and reporting policies. All information provided is kept confidential and reported only in aggregate form. I further understand that the completion of this application does not guarantee approval for any expense reimbursements.

First Name *

Last Name *

Title

Email address *

Preferred Contact Telephone Number *

The US Small Business Administration (SBA) would like to give eligible small business concerns the opportunity to expand your knowledge and resources of other programs that are offered by the agency. Please check the appropriate box if you would like for your company’s name and contact information to be shared with other programs offered by SBA. Your choice to participate or not, will not change the status of your participation with STEP. SBA’s aim is strictly to share information about other opportunities with you. *

Yes No

Date *

Month Day Year