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       Tariff Retrieval Registration Form


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.

Company Name:_____________________________________________

Address:___________________________________________

___________________________________________________

City, State/Province, Postal Code and Country:

___________________________________________________

 

Full Name: ________________________________________

Title:______________________________________________

Phone:_______________________________

Fax: _________________________________

E-Mail:_______________________________

 

Carrier Organization Registering for:?

Name: _____________________________________________

Org Number: _______________________________________

Access Fee:  Standard of $50.00 for 3 months, payable in advance.  Non-refundable.  Total Due $150.00, or (see exception list) for alternate amount.

Please Check One of the Following:
  ____   Shipper
  ____   Forwarder
  ____   Steamship Line/Conference
  ____   NVOCC
  ____   Other

Connection Type, Check one:
  ____   Dial-up Modem 28k - 56k
  ____   Network/ISDN/Cable 128k+


Review our Privacy Statement

____ 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.


INSTRUCTIONS:

Print this document and MAIL to carrier address, along with payment.  Make check payable in name of carrier.  For Wire Transfers, contact carrier directly for payment instructions.  Contact DMS staff for current contact and mailing address information. Be sure to include carrier(s) name in your request.

registration@dartmaritime.com; 704-357-6414 (fax)

DO NOT send registration form to Dart Maritime.


FOR CARRIER USE ONLY:

Complete section below and fax to 704-357-6414 to authorize issuance of login/password to above registrant.

Approved By: ___________________________

Title: __________________________________

Date: __________________________________

Signature: ______________________________

Expiration Date:__________________________

 


 

FOR DART MARITIME USE ONLY:

Login: __________________________________

Password: ______________________________

Date: ___________________________________

Registrant Notified: ________________________