Import (non CHB) Package

Follow the step-by-step below

IMPORT PACKAGE (NON CHB)

Step 1
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Step 4
Step 5

New Client Questionnaire

Type of Business

Individual

Corporation

Limited Liability Company

Sole Proprietorship

General Partnership

Limited Liability Partnership

Company Name

First Name

Last Name

Billing Address

City

State

ZIP Code

Country

Delivery Address (if different)

City

State

ZIP Code

Country

E.I.N or Customs Assigned Number:

Social Security Number or Customs Assigned Number:

DUNS#:

Contact person to coordinate the service

Email Address

Phone number

Fax

Contact person for payments / Accounts payable

Email Address

Phone number

Fax

Who is your sales representative?

Importer Information

Type of Business:

Government Issued Identification

Individuals importing into the US are required to provide a copy of a government issued ID. Examples include: Driver’s License, State Issued ID, Passport, Work Visa, Green card, DOD or Military ID

Upload a copy of your government issued ID

Choose File

Upload a copy of your Social Security Card

Choose File

Upload a copy of your SS4 Form (Letter from the IRS assigning your E.I.N number)

Choose File

Name:

Social Security Number:

Company name:

Do you have a registered DBA?

Yes

What is your DBA?

Is the company a foreign entity?

Tax ID# (EIN or Customs Assigned #):

Address: - - - -

I have read and agree to the Terms and Conditions

Signature

By checking this box, I acknowledge and agree that I am providing my electronic signature.

Full Name of Signer

Initials

Phone Number of Signer

Email Address of Signer

C-TPAT SECURITY QUESTIONNAIRE

Name:

Company Name:

Address: , , , ,

Name of the Person Completing Form:

Email:

Telephone:

Is your company currently CTPAT certified?

YES

Are you currently CTPAT certified?

YES

If YES, initiate an SVI monitoring request by doing the following: 1) Log in to your C-TPAT Portal account; 2) Select the "Status Verification" link; 3) Select the "Request Monitoring" tab; 4) Enter our company's name in the search box (you must enter at least three characters); 5) Our company will show in the list that appears; 6) Click the "Select box" next to our company name.

Has your company started the process of becoming C-TPAT certified?

YES

Have you started the process of becoming C-TPAT certified?

YES

Have you made an analysis of your existing security criteria and procedures?

YES

Have you submitted the online business profile on the C-TPAT web portal?

YES

Have you started the process of completing the online security profile on the C-TPAT web portal?

YES

Have you submitted the online security profile on the C-TPAT web portal?

YES

Does your company participate in any of the following government sponsored supply chain security programs?: Export Scheme Program (New Zeland), Partners in Protection (Canada), Golden List Program (Jordan), Authorized Economic Operator (Japan, Korea, European Union, Taiwan or Israel), NEEC- Nuevo Esquema de Empresa Certificada (Mexico), Secure Trade Partnership (Singapore), Other program.

YES

Do you participate in any of the following government sponsored supply chain security programs?: Export Scheme Program (New Zeland), Partners in Protection (Canada), Golden List Program (Jordan), Authorized Economic Operator (Japan, Korea, European Union, Taiwan or Israel), NEEC- Nuevo Esquema de Empresa Certificada (Mexico), Secure Trade Partnership (Singapore), Other program.

YES

Indicate below in which government sponsored supply chain programs you participate:

Export Scheme Program (New Zeland)

YES

Partners in Protection (Canada)

YES

Golden List Program (Jordan)

YES

Authorized Economic Operator (Japan)

YES

Authorized Economic Operator (Korea)

YES

Authorized Economic Operator (European Union)

YES

Authorized Economic Operator (Taiwan)

YES

Authorized Economic Operator (Israel)

YES

NEEC (Nuevo Esquema de Empresa Certificada (Mexico)

YES

Secure Trade Partnership (Singapore)

YES

Do you participate in any other government sponsored supply chain program?

YES

Name of the program

Provide copies of all certificates and pertinent documents

Choose File

Signature of the person completing this questionnaire:

CARGO INSURANCE

Do you request cargo insurance protection on shipments handled by A1 Worldwide Logistics?

Yes, I request cargo insurance protection on all shipments handled by A1 Worldwide Logistics Inc.

No, I do not want cargo insurance protection on all shipments handled by A1 Worldwide Logistics Inc.

Name:

Company Name:

Contact Name:

Phone Number:

Email:

Signature:

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A1 Worldwide Logistics

1035 NE 125th St #320, North Miami, FL 33161