FDB CERTIFIED - Membership Application

Certification Application

Company Name: *

Business Type
(i.e. LTD, Inc, Corp ,etc): *

Main Office Address:*

Country:*

City:*

State:

Telephone:*

Fax:

After Hours Telephone Number:

Website

Additional Locations/Branch Offices:

Year business was started:*

Number of Employees:*

Company Contacts you want listed on the FDB membership website for additional contacts please copy and past the format to supply as many contacts as your company needs or desires

Contact Name:*
Title:*
Email:*
Direct Line:
Mobile Phone:


Contact Name:
Title:
Email:
Direct Line:
Mobile Phone:

Contact Name:
Title:
Email:
Direct Line:
Mobile Phone:

Contact Name:
Title:
Email:
Direct Line:
Mobile Phone:

Contact Name:
Title:
Email:
Direct Line:
Mobile Phone:

Add More Contact

List of emails you want to receive the monthly newsletter

0 characters entered.

Should not more than 2 emails, 80 Characters
(Example email1@yourwebsite.com,email2@yourwebsite.com)

List of emails you want to receive special alerts about notorious individuals or companies

0 characters entered.

Should not more than 2 emails, 80 Characters
(Example email1@yourwebsite.com,email2@yourwebsite.com)

*Services:*
Airfreight:
Customs Brokerage:
Ocean Freight:
Rail
Trucking
Warehouse
Other:

Lincenses/Certifications:

Customs Broker:

NVOCC:

Bond Number (if U.S.):

OTI ( U.S. ONLY):

OTI License Number:

ISO Certified:

FIATA:

IATA/CNS:

Certification#:

Network Memberships

Other Membership's(Networks) or Certification

Please send FDB a scanned copy of each license or certificate your company possesses that you have said yes to above.

Selected Selected Selected

*Please list the individuals, entities, or other ownership structure of your company.*
Company Ownership
Name 1:
Percent Owned1:	%
Name 2:
Percent Owned2:	%
Name 3:
Percent Owned3:	%
Capitalization (optional):
Specify Currency
If Public: Stock Exchange:
Shares Outstanding:
Price:
Currency:

*Affiliations:*
Please list any other private trade groups to which you belong: Trade or Industry References & export, airfreight, custom formalities, trucking, regular consol boxes in import & export
*Reference1*
Company Name:
Skype:
Type of business:
Contact:
Country:
Phone:
Fax:
Email:
*Reference2*
Company Name:
Skype:
Type of business:
Contact:
Country:
Phone:
Fax:
Email:
*Reference3*
Company Name:
Skype:
Type of business:
Contact:
Country:
Phone:
Fax:
Email:
Does your company maintain an E&O policy?
Underwriter:
Name of Applicant:*
E-mail:*
* Plese validating this image