Our Road Map

8th Annual Conference

Members Only

membership questionnaire

**** Please be reminded that approval to be a member of GLN gives you Platinum Status as you have paid USD 500.00 towards the AR Fund. ONLY those offices paid and registered can be part of that fund. If you have other offices and not registering them, you may wish to cover them in AR Fund for $200.00 per office**** 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:

GLN allows maximum of 3 per city : Specify Cities:

Section 1- Corporate/Headquarters Information:

(Please no NOT use all CAPITAL LETTERS)

Full legal 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:

Year business started*:

Number of employees*:

Emergency Tel/Mobile #

(inc. country code)

Hours +/- from GMT:

Are you locally owned*?:

YES NO

If NO, please explain*:

Corporate Licenses:

Customs Brokerage

Dangerous Goods

FMC (USA Only)

ISO 9000

FIATA

IATA/CNS

Please provide Corporate

License Numbers:

FMC:

FIATA:

IATA/CNS:

Memberships & Affiliations*:

How did you hear

about GLN?*:

If recommended by

another GLN Member,

please give details:

Total Annual

Billing/Revenue

(US Dollars)*

Air Export*:

Ocean

Export*:

Import & Brokerage*:

Warehousing & Logistics*:

Other*:

Total*:

Detailed description/overview of your Company to be displayed on the website entry:

	Name of Key Contact:	Job Title	Email Address	Skype/MSN/Cell Number:
Primary GLN Contact:
Sales Contact:
Operations Contact:
Accounting/Finance Contact:

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 - Branch #I Details:

(Leave Blank if same as Corporate/Headquarters Information)

Address:

City:

State/County:

Zip/Postcode:

Telephone:

(inc. country code):

Fax:

(inc. country code):

Work Hours (weekdays):

Work Hours (weekends):

Emergency #:

Section IV - Branch #2 Details:

(Leave Blank if not applicable)

Address:

City:

State/County:

Zip/Postcode:

Telephone:

(inc. country code):

Fax:

(inc. country code):

Work Hours (weekdays):

Work Hours (weekends):

Emergency #:

Section V - Branch #3 Details:

(Leave Blank if not applicable)

Address:

City:

State/County:

Zip/Postcode:

Telephone:

(inc. country code):

Fax:

(inc. country code):

Work Hours (weekdays):

Work Hours (weekends):

Emergency #:

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. Please be sure to review rules attached to the GLN AR Fund Here is link http://www.go2gln.com/arfund.html

Your name here	Your Company Name	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.