Tariffcenter.com
Tariff Retrieval Registration Form
You must agree to these terms to receive a login id and password. 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+
____ 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.
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: ________________________