| 
			Company
			Information 
			 Enter
			the required company information below.  
			 .3.1
			    Company
			Name
			
			 Enter
			a company name 
 .3.2
			   Company
			Doing Business As 
			
			  
 .3.3
			   Company
			Telephone  
			
			 Enter
			a company telephone number 
 .3.4
			   Company
			Fax  
			
			  
            Primary
			Address 
			 Enter
			the primary address of the company. .4.1
			   Type
			
			
			 The
			type is required. 
 .4.2
			  Country/Territory
			 
			
			 The
			country is required. 
 .4.3
			   Street
			Address    
			
			 The
			address line 1 is required. 
 .4.4
			   Street
			Address 2  
			
			  
 .4.5
			   City
			 
			
			  The
			city is required.
			Please
			enter a valid city.
			
			 .4.6
			   State
			  
			
			 The
			state is required. .4.7
			   Zip/Postal Code  
			
			 The
			postal code is required. .4.8Is
			the address also a mailing address?
			
			  Other
			Addresses 
			 
				
				
					| 
						There
						are no other addresses. |  Add
			New Address
			
			 
				
				
					| 
						Additional
						Company Information 
						 Select
						the appropriate answers below. 
						 
 .5.1
						   Owner
						Type  
						
						 Select
						an owner type 
 .5.2
						   Years
						In Business  
						
						 Select
						the number of years in business .5.3
						   Number
						of Employees  Select
						the number of employees
 
							
							
								| 
									Company
									Contacts 
									 Enter
									all of the contacts from your company that will be
									participating in the C-TPAT program. Ensure that you have
									selected a designated Point of Contact (POC) who is an
									officer of the company. NOTE:
									If you need to change the email address of an existing
									contact, please delete the existing contact, then add a new
									contact with the new email address.
 .6.1Contacts
									
									 
									Contact
									Details   Please
									enter at least one contact who is a point of contact. You
									can only be one of the listed contacts. Make sure 'Are you
									this user?' is only selected for one contact.
 Email
									addresses must be unique to one contact. Please make sure
									that more than one contact is not using the same email
									address.
									A
									company officer must be listed as a contact.
									  
										
										
											| 
												Company
												Contacts 
												 Enter
												all of the contacts from your company that will be
												participating in the C-TPAT program. Ensure that you have
												selected a designated Point of Contact (POC) who is an
												officer of the company. NOTE:
												If you need to change the email address of an existing
												contact, please delete the existing contact, then add a
												new contact with the new email address.
 Contact
												Details 
												 
													
													
													
														|   | 
															.6.2
															    Salutation
															   
															
															  Select
															a contact type
 |  
														|   | 
															.6.3
															     First
															Name
															  
															  Enter
															a first name
 Please
															enter a valid first name
 |  
														|   | 
															.6.4
															    Last
															Name
															    
															  Enter
															a last name
 Please
															enter a valid last name
 |  
														|   | 
															.6.5
															    Contact
															Title  
															
															  Enter
															a title
 |  
														|   | 
															.6.6
															    Telephone
															      
															  Enter
															a telephone number
 |  
														|   | 
															.6.7
															    Email
															Address 
															
															  Enter
															an email address
 
 |  
														|   | 
															.6.8
															    Confirm
															Email Address  
															
															  Confirm
															your email address
 Email
															Address and Confirm don't match
 |  
														|   | 
															.6.9
															   Secondary
															Email Address   
															
															  
 |  
														|   | 
															.6.10
															  Confirm
															Secondary Email Address   
															
															  Secondary
															Email & Confirm don't match
 |  
														|   | 
															.6.11
															 Contact
															Type  
															
															  Select
															a contact type
 This
															contact type is not a valid Point of Contact
 |  
														|   | .6.12
															  Primary
															Company Point of Contact (POC)
															
															  |  
														|   | 
															.6.13
															   Are
															you this user?
															
															  
 |  
														|   | 
															.6.14
															   Contractor
															Company Name  
															
															  Enter
															the company name
 |  
														|   | 
															.6.15
															   Contractor
															Business ID  
															
															  Enter
															the business ID
 |  
														|   | .6.16
															   Country
															 
															
															  Select
															a country
 |  
														| 
 | 
 |  
														|   | 
															.6.17
															   Street
															Address 1
															  
															  Enter
															the street address
 |  
														|   | 
															.6.18
															   Street
															Address 2   
															
															  
 |  
														|   | .6.19
															   City
															 
															
															  Enter
															the city
 Please
															enter a valid city name
 |  
														|   | 
															.6.20
															   State
															
															 
   Select
															a state
 |  
														|   | .6.21
															   Zip/Postal
															Code   
															
															  Enter
															the zip/postal code
 |  
 |  
 |  
								| 
									      
										
										
											| 
												Business
												Information 
												 .7.8
												  In
												the past 24 months, how many crossings with freight did
												you transport under your operating authority into the
												United States?
												
												 Enter
												the number of freight crossings
												Enter
												a numeric value .7.9
												  U.S.
												Department of Transportation (DOT) issued Number
												
												 DOT
												issued number must be a five to seven character
												alphanumeric code .7.10
												 U.S.
												National Motor Freight Traffic Association issued
												Standard Carrier Alpha Code (SCAC)
												
												 SCAC
												must be a four digit alphabetical code Additional
												IOR Numbers .7.11
												   Additional
												ID
												
												 IOR
												Number must be in the format of ###-##-####, ##-#######??
												(where the last two characters are alphanumeric), or
												######-#####
												IOR
												Number must be in the format of ###-##-####, ##-#######??
												(where the last two characters are alphanumeric), or
												######-#####
												Manufacturer
												ID must be a maximum of 15 alphanumeric characters with
												the first two being the alphabetical ISO Country Code
												Manufacturer
												ID must be a maximum of 15 alphanumeric characters with
												the first two being the alphabetical ISO Country Code      
 .7.12
												    Entered
												IDs
												
												  Enter
												any terminals or warehouses that you own and their
												addresses: 
													
													
														| 
															There
															are no highway terminals. |  Add
												Terminal
 
    
 .7.13
												  Depress
												and hold the Control (Ctrl) key to select multiple border
												crossing locations
												
												 Select
												at least one border crossing .7.14
												   Depress
												and hold the Control (Ctrl) key to select the services
												that you offer
												
												 Select
												at least one service provided .7.15
												   Depress
												and hold the Control (Ctrl) key to select the sources for
												your drivers
												
												 Select
												at one source of drivers |  
											| 
												      |  
									  
										
										
											| 
												Mutual
												Recognition Agreement 
												 Consent
												for Disclosure of Customs-Trade Partnership Against
												Terrorism (C-TPAT) Information to the Specified Country
												Government Officials Upon
												completion of this consent, C-TPAT will be authorized to
												provide the information outlined below to government
												officials for the country specified. The information will
												only be provided to those government officials directly
												responsible for the program in which the United States
												Customs and Border Protection has entered into Mutual
												Recognition. The
												information that will be released will be: Your
												company has the right to revoke this consent at any time
												by removing the check block for that country. The
												revocation will not have any effect on any actions taken
												in reliance on the consent prior to the time consent was
												revoked. .8.1
												  Agreement
												
												 I
												Agree .8.2
												   Countries
												
												 
													
													
														|  Canada
 |  
														|  Japan
 |  
														|  Jordan
 |  
														|  New
															Zealand (Aotearoa)
 |  Please
												select at least one country from the list.
												
												 |  
											| 
												
 |  
											| 
												C-TPAT-Partner
												Agreement to Voluntarily Participate This
												Agreement is made between xx (hereafter referred to as
												"the Partner") and U.S. Customs and Border
												Protection (hereafter referred to as "CBP").
												
 This Agreement between the Partner and CBP
												will enhance the joint efforts of both entities to better
												secure the international supply chain to the United
												States. CBP and the Partner recognize the need to improve
												and expand existing security practices in order to
												achieve a more efficient and compliant import process.
 
 The Partner agrees to develop and implement,
												within a framework consistent with the listed C-TPAT
												criteria, a verifiable and documented program to enhance
												security procedures throughout its supply chain. Where
												the Partner does not exercise control of a production
												facility, distribution entity, or process in the supply
												chain, the Partner agrees to communicate the C-TPAT
												criteria to those entities.
 
 Specifically,
												the Partner agrees to: 
												 
													
													Commit
													to working with business partners and CBP to meet C-TPAT
													minimum security criteria. 
													Using
													the online application process (the C-TPAT Security Link
													Portal), complete a supply chain security profile and
													update information regarding the company on an annual
													basis. 
													Provide
													complete and accurate company information in response to
													C-TPAT inquiries. 
													Comply
													with C-TPAT program requirements to ensure integrity at
													each stage of the Partner�s
													supply chain. 
													Cooperate
													with the C-TPAT validation process including assisting
													the CBP Supply Chain Security Specialists (SCSS) in
													planning for and conducting site visits. 
													Acknowledge
													and cooperate with re-validation procedure as deemed
													necessary by CBP. 
													Maintain
													security integrity throughout the partnership,
													conducting periodic self-assessments in line with the
													changing risks and complexity of international business
													and trade. 
													Cooperate
													with CBP, domestic and foreign port authorities, foreign
													customs administrations and others in the trade
													community, in advancing the goals of C-TPAT and the
													Container Security Initiative (CSI). 
													
													Acknowledge
													and accept this Agreement to Voluntarily Participate by
													marking the �I
													agree�
													box below. 
													 Upon
												acceptance, review, and/or certification in the C-TPAT
												program, CBP will: 
												 
													
													Assign
													a Supply Chain Security Specialist (SCSS) to work
													individually with the Partner in C-TPAT procedures. 
													Review
													the Partner�s
													C-TPAT application within 90 days of receipt. 
													Conduct
													a C-TPAT validation within one year of the Partner�s
													C-TPAT certification in accordance with section 215 (a)
													of the �Security
													and Accountability for Every Port Act of 2006�
													(SAFE Port Act), Pub. L. 109-347, 120 Stat. 1917. CBP
													will, to the extent possible, be flexible to the
													Partner�s
													scheduling availability. 
													Provide
													the Partner with feedback regarding the validation
													including any security enhancement recommendations,
													actions required, and recognition of CBP identified best
													practices. 
													Endeavor
													to assist the Partner with security threat awareness
													training and in identifying high risk factors specific
													to the Partner�s
													operating environment(s). 
													Not
													request that the Partner take any action which would
													conflict with any U.S. laws or regulations relevant to
													the Partner�s
													operations. 
													Provide
													C-TPAT participant verification capability via the
													Status Verification Interface (SVI). 
													Conduct
													re-validations in accordance with time frames set forth
													in section 219 of the SAFE Port Act. 
													Allow
													the Partner a reasonable timeframe within which to
													comply with and/or implement security practices or
													measures that represent an amendment or change to
													current C-TPAT imposed requirements. 
													Where
													feasible and to the extent practical, extend specific
													C-TPAT benefits to Partners at U.S. ports of entry. 
													
													Provide
													the opportunity for C-TPAT Partners to be eligible to
													participate in the developing Mutual Recognition Program
													by exchanging information with foreign administrations,
													which may enable C-TPAT partners to receive more
													benefits, but only through prior consent of the C-TPAT
													member. 
													 CBP
												acknowledges that during the course of the C-TPAT
												membership relationship between CBP and the Partner, CBP
												may become privy to proprietary business information. CBP
												recognizes the confidential nature of such information,
												and agrees to take the appropriate measures to maintain
												the confidentiality of this information in accordance
												with U.S. law. 
 This Agreement is subject to
												review by the Partner or CBP and may be terminated with
												written notice by either party.
 
 This
												Agreement cannot, by law, exempt the Partner from any
												statutory or regulatory sanctions in the event that
												discrepancies are discovered during a physical
												examination of cargo or the review of documents
												associated with the Partner�s
												CBP transactions.
 
 Nothing in this Agreement
												relieves the Partner of any statutory or regulatory
												responsibilities under United States law, including any
												requirements imposed under DHS and CBP statutes and
												regulations.
 
 xx
												Company Name
 
 
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