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: 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:
  ____   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, scan and email to rates@dartmaritime.com for processing.




FOR CARRIER USE ONLY:

Complete section below and fax to 704-631-4667 or email scanned document to rates@dartmaritime.com 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: ________________________