Please PRINT and complete the registration form below and our staff will contact you with your User ID and Password after approval by carrier. A copy of this form MUST be completed for each Carrier requested and payment in proper amount MUST accompany this registration form.
City, State/Province, Postal Code and Country:
Full Name: ________________________________________
Carrier Organization Registering for:?
Org Number: _______________________________________
Access Fee: Determined by hosted Carrier. Dart Maritime Service does not set or determine pricing for access to published tariff data.
Please Check One of the Following:
____ Steamship Line/Conference
Connection Type, Check one:
____ Dial-up Modem 28k - 56k
____ Network/ISDN/Cable 128k+
____ By checking this box I agree to the terms and conditions set forth and certify
that I have reviewed and understand the "tariff retrieval agreement".
____ I am authorized to enter my company into this agreement.
You must agree to these terms to receive a login id and password.
Print this document, scan and email to email@example.com for processing.
FOR CARRIER USE ONLY:
Complete section below and fax to 704-631-4667 or email scanned document to firstname.lastname@example.org to authorize issuance of login/password to above registrant.
Approved By: ___________________________
FOR DART MARITIME USE ONLY:
Registrant Notified: ________________________