Global Insurance Network, Inc.

A World of Service for Worldwide Services!

Federal ID Number (IRS #) or SS:

Name of Firm and Address:
If Individual: first, middle, last Name

Business Phone Number:

Business Fax Number:

The Bond Will Cover
check as appropriate

	Cartman		Container Freight Station
	Common Carrier		Bonded Warehouse
	Foreign Trade Zone		Centralized Exam Station
	Airport Security		For Immediate Export (I.E. 63)

If Common Carrier, state port where you will be transporting merchandise to and from.

From:

To:

If Container Station(s) or Proprietor's warehouse(s), give the exact physical location(s) of each.

Location:

Type of Merchandise Handled
check as appropriate

General Merchandise

Alcohol

Tobacco

Have you been operating as a customs approved custodian (i.e. holding a customs custodial license) in the past or presently?

Please list the Port(s) where you have been approved to operate:

What importer number(s) have/do you use(d) when operating as a customs approved custodian? Please list all numbers:

CERTIFICATION

I certify that the factual information contained in this application is true and accurate and is based upon the best information available on the date of this application.

Name:		Title:
Email:		Date:

Copyright © Global Insurance Network, Inc. All Rights Reserved.
All trademarks and brands are property of their respective owners.
Use of this web site constitutes acceptance of the Terms of Use and Privacy Policy.