DOMINICAN REPUBLIC TWO FOR ONE EARNED IMPORT ALLOWANCE PROGRAM TRANSACTION FORM

DOMINICAN REPUBLIC TWO FOR ONE

EARNED IMPORT ALLOWANCE PROGRAM
TRANSACTION FORM

Type of Transaction:
Request to Establish a New Account
Request to Deposit Credits into an Existing Account

For all transactions, please provide the following information about your company:

COMPANY NAME
IMPORTER OF RECORD NUMBER
CONTACT PERSON(S):
ADDRESS:
TELEPHONE NUMBER:
FAX NUMBER (if available):
EMAIL ADDRESS:
WEBSITE (if available)
HOW IS APPLICANT QUALIFIED?	We are, or are affiliated with, a Dominican Republic apparel manufacturer. We have a contract with a Dominican Republic apparel manufacturer to produce on our behalf. Other (please specify):

LIST OF SUPPORTING DOCUMENTS CONTAINED IN ATTACHED FILES:

(only Adobe Acrobat and Microsoft Word files are accepted)

NOTE: Please be aware that the Earned Import Allowance Online System cannot accept files larger than 10MB. However, account holders may submit multiple requests for deposits for the same fabric purchase, but must indicate that the requests as "Part 1", "Part 2", etc. Should you have any questions, please contact OTEXA at 202-482-3400

I HEREBY AFFIRM THAT THE INFORMATION CONTAINED IN THIS TRANSACTION REQUEST IS ACCURATE. I UNDERSTAND THAT OTEXA MAY, AT ANY TIME, INDEPENDENTLY VERIFY THE INFORMATION THAT I HAVE SUBMITTED ABOVE. I ALSO UNDERSTAND THAT OTEXA MAY ESTABLISH AND IMPOSE PENALTIES FOR THE SUBMISSION OF FRAUDULENT INFORMATION UNDER THIS PROGRAM, OTHER THAN A CLAIM UNDER THE CUSTOMS LAWS OF THE UNITED STATES OR UNDER TITLE 18, UNITED STATES CODE.

Yes
No

Submitted by:

NAME OF REQUESTOR
DATE