LOS ANGELES CUSTOMS BROKERS   & FREIGHT FORWARDERS

AFFILIATE MEMBERSHIP APPLICATION 

We would like to apply for membership in LACBFFA

FIRMFi   Firm	Address
City/Zip	Website
Year Est.	No. Employees

AUTHORIZED REPRESENTATIVES

(List three with Phone, Fax and Email

Name	Phone
Fax	Email
Name	Phone
Fax	Email
Name	Phone
Fax	Email

BUSINESS SERVICES PROVIDED

Steamship Comp/Agency	Motor Carrier	Airline
Computer Svc.	Warehousing	Ins/Bonding
Export Packer	Port Authority	Attorney
Accountant	Publisher	Other
ANNUAL DUES $350.00

Enclosed is our check #__________ to cover the first year’s dues.

Credit Card Payment   Visa______ M/C_______Exp.Date_______3 Digit Code_______

Credit Card Number:_____________________________________________________

Name on Card ________________________Signature___________________________

Date_________________

                                      Please fill out then copy, paste and send     Email: la.cbffa@verizon.net