membership questionnaire

Submitting the application does not mean that your company has been approved for membership!

Items shown with a * are confidential and will not be revealed - all other items will be visible to other GLN Members

Application in respect of:

Specify Cities:

Section 1- Corporate/Headquarters Information:

Company Name:

Trading Name (If different):

Address:

City:

State/County:

Zip/Postcode:

Corporate Telephone:

(inc. country code)

Corporate Fax:

(inc. country code)

Corporate Email:

Website:

Key Contact Name:

Key Contact position/title:

Key Contact Email:

Number of employees*:

Year business started*:

Sykpe/AIM/MSN:

Business Registration

Number/location*:

Business Registration Date*:

Are you locally owned*?:

YES NO

If NO, please explain*:

Do you have any ownerships

outside your local country*?:

YES NO

If YES, please explain*:

Corporate Licenses:

Customs Brokerage

Dangerous Goods

FMC (USA Only)

ISO 9000

FIATA

IATA/CNS (USA Only)

Please provide Corporate License Numbers:

FMC:

FIATA:

IATA/CNS:

Other Memberships & Affiliations*:

How did you hear about GLN?*:

If recommended by another GLN Member, please give details:

Does your company maintain an E&O (Errors & Omissions) Insurance?*:

YES NO

If yes, Underwriter*:

Annual Billing/Revenue

(US Dollars by service*)

Air Export*:

Ocean Export*:

Import & Brokerage*:

Warehousing & Logistics*:

Other*:

Total*:

Detailed description/overview of your Company to be displayed

on the website entry within our website, if you are approved:

Section II - References

Must include your Bank, an Airline or Steamship Line or an Overseas Agent/Partner

Reference #1 - Bank

Bank Name*:

Bank Address*:

Bank Contact Name/Title*:

Bank Account Number*:

Bank Fax Number*:

Reference #2 - Airline or Steamship Line

Company Name*:

Contact Name/Title*:

Email Address*:

Reference #3 - Airline, Steamship Line or Overseas Agent:

Company Name*:

Contact Name/Title*:

Email Address*:

Section III - Headquarters/Main Branch Details:

Address:

City:

State/County:

Zip/Postcode:

Telephone (inc. country code):

Fax (inc. country code):

Branch Email:

Number of employees*:

Work Hours (weekdays):

Work Hours (weekends):

Size of Warehouse*:

Size of Bonded Warehouse*:

Emergency Telephone Mobile/Cell #

Services Offered:

(use CTRL and click for multiple options)

Number of forklifts*:

Number of trucks*:

Name of Key Contacts:

Titles

Email Addresses

Skype/Mobile Numbers:

Section IV - Branch 1 Details:

Address:

City:

State/County:

Zip/Postcode:

Telephone (inc. country code):

Fax (inc. country code):

Branch Email:

Number of employees*:

Hours of operation (weekdays):

Work Hours (weekends):

Size of Warehouse*:

Size of Bonded Warehouse*:

Emergency Number:

Services Offered:

(use CTRL and click for multiple options)

Number of forklifts*:

Number of trucks*:

Name of Key Contacts:

Titles

Email Addresses

Skype/Mobile Numbers:

Section V - Branch 2 Details:

Address:

City:

State/County:

Zip/Postcode:

Telephone (inc. country code):

Fax (inc. country code):

Branch Email:

Number of employees*:

Hours of operation (weekdays):

Work Hours (weekends):

Size of Warehouse*:

Size of Bonded Warehouse*:

Emergency Number:

Services Offered:

(use CTRL and click for multiple options)

Number of forklifts*:

Number of trucks*:

Name of Key Contacts:

Titles

Email Addresses

Skype/Mobile Numbers:

If you have more than 3 locations, please submit the initial information and then re-submit this form with only the additional Branch Information included.

Your name here	Your Company Name	Your City/Country here	Your email here	Date here

WARNING: When you click to submit, we will record your ISP, Remote Computer Name and Username for security purposes.

It may take up to a minute for all information to be submitted. Please do not re-submit.