Fillable Long Term Credit / Guarantee - Acquisition List (Export-Import Bank of the United States)

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Long Term Credit / Guarantee - Acquisition List (Export-Import Bank of the United States)

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Note: The following document applies to new transactions that are documented under the revised Master Guarantee Agreement (March 2001)
EXPORT-IMPORT BANK OF THE UNITED STATES
Long Term Credit / Guarantee - Acquisition List
Effective Date:
Exporter’s Name, U.S. Street Address, Tel./Fax. #s:
Supply Contract/Purchase Order Number: __________________
RE: Ex-Im Bank Credit/Guarantee Number:
Authorized Party Providing Information: Signature:
Project Name/Identification:
Purchaser: Country:
To the best of our knowledge the following is true and accurate, representing the identifiable or most likely procurement (sources and description of goods and
services) covered under the Credit / Guarantee.
Section A - U.S. Procured Goods and Services
Reference
#
Description of Goo ds a/o Serv ices (including model, #u nits if
applicable) SIC or NAICS code
Manufacturer & address of
manufactur e, plus (if different)
Exporter & a ddress
USD U.S. Export
Value of described
Products a/o Services
(U.S. Contract Amount)
Est. Date
of
Shipping
or service
execution
$
$
$
$
Print Form
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signature
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EXPORT-IMPORT BANK OF THE UNITED STATES
Long Term Credit / Guarantee - Acquisition List
(continuation page U.S. Procured Goods and Services) of
RE: Project Name/Identification: Effective Date:
Section A - U.S. Procured Goods and Services (continued)
Reference
#
Description of Goods a/o Serv ices (including model, #u nits if
applicable) SIC or NAICS code
Manufacturer & address of
manufactur e, plus (if different)
Exporter & a ddress
USD U.S. Export
Value of described
Products a/o Services
(U.S. Contract Amount)
Est. Date
of
Shipping
or service
execution
_______
$
$
$
$
$ _______
Net Contract Price :
Estimated Foreign Content
in Net Co ntract Price :
$
$
EXPORT-IMPORT BANK OF THE UNITED STATES
Long Term Credit / Guarantee - Acquisition List
(continuation page for Local Goods and Services)
of
Local Cost Provider’s Name, Street Address, Tel./Fax. #s:
RE: Project Name/Identification: Effective Date:
Section B - Local Goods and Services
Reference
#
Description of Goo ds a/o Serv ices (including model, #u nits if
applicable) SIC or NAICS code
Manufacturer & address of
manufacture
USD Expected $
Value of described
Products a/o Services
Est. Date
of Supply
$
$
$
$
Total Associated Local Costs:
$
Date:_____________Sections A and B have been reviewed and approved by E&E Division: Initials:
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Long Term Credit Guarantee - Acquisition List (Export-Import Bank of the United States)

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Completed 10 August 2020

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