Post Point of Contact Name:

Email Address:

Telephone Number: Fax Number:

Post City and Country:

Lease Number:

Type of Lease: Office Residential (If residential, provide the name of tenant)

Lease Start Date: Lease End Date:

Terms of Lease:

Annual Amount of Lease: (In U.S. Dollars)

Payments are Made: Monthly Quarterly Annually Semi-Annually Other (Please specify in "terms of lease" section)

Please indicate which month(s) payment is due: January February March April May June July August September October November December

Conversion Rate Used:

Current Payment Information: (Please include date of payment, period covered with payment, and current exchange rate used for each payment.)


* PLEASE mail or fax this form and all supporting documents to the ITA Accounting Office
U.S. Department of Commerce, 14th & Constitution Ave., NW , Attn: Crystal Bush, Room 4113
Washington, DC 20230, Fax Number: 202/482-5584. (Please provide the Headquarters Commercial Services with this documentation.)