LOS ANGELES CUSTOMS BROKERS   & FREIGHT FORWARDERS

REGULAR MEMBERSHIP APPLICATION

We would like to apply for membership in LACBFFA

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

Customs Broker	NVOCC
CHB Lic. #	FMC#

DUES DETERMINED BY NUMBER OF EMPLOYEES

1-3	$200/year
4-30	$300/year
31 or more	$400/year

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

Credit Card Payment : Visa______ M/C_______Exp.Date_______3 Digit Code_______

Card Number:___________________________________________________________

Name on Card________________________Signature___________________________

Date_________________

Please note: You must submit a copy of your license and permit with the application to be approved for membership.