Georgia Ports Authority

For any inquiries, please contact
Carol Sheppard
P.O. Box 2406
Savannah, Georgia 31402
Phone (912) 966-7814
Fax (912) 966-3629


Application For Credit

* (required)

Legal Name / Trade Style of Firm:
*
Street Address:
*
City:
*
State:
*
Zip:
*
Telephone:
*
Fax:
Web Site:
TYPE OF BUSINESS
Ship Agency
Stevedore

Shipper

CH Broker / Freight Forwarder
Other, please explain

   
Federal Tax ID
*
FMC License #:
C-TPAT Member, SVI:

Number of years company has been in business: *

The amount and / or frequency of cargo volume anticipated to be shipped through the GPA: *

Corporation
Partnership

Proprietorship

Other, please explain

Date of incorporation:
*
State of incorporation:
*
President: / CEO:
*
Chief Financial Officer:
*
   
Accounts Payable Manager:
*
Telephone:
*
Email:
Accounts Payable Contact:
*
Telephone:
*
Email:

 

BANK REFERENCE
Bank Name:
*
Street Address:
*
City:
*
State:
*
Zip:
*
Telephone:
*
Fax:
Account Number(s):
*
Bank / Account Officers Name:
*
BUSINESS REFERENCE 1
Company Name:
*
Street Address:
*
City:
*
State:
*
Zip:
*
Contact Name:
*
Email:
Telephone:
*
Fax:
FAX OR E-MAIL MUST BE PROVIDED
BUSINESS REFERENCE 2
Company Name:
*
Street Address:
*
City:
*
State:
*
Zip:
*
Contact Name:
*
Email:
Telephone:
*
Fax:
FAX OR E-MAIL MUST BE PROVIDED

 

BY PRESSING THE SUBMIT BUTTON BELOW, AN APPLICATION WILL BE SUBMITTED TO THE GEORGIA PORTS AUTHORITY (GPA) FOR THE PURPOSE OF OBTAINING CREDIT. BY ENTERING YOUR NAME, TITLE AND (CORPORATE INFORMATION) BELOW, YOU EXPRESSLY AUTHORIZE GPA TO INQUIRE, VERIFY OR OBTAIN ANY INFORMATION THEY DEEM NECESSARY RELATED TO YOUR CREDIT STANDING AND REPRESENT THAT YOU INTEND THE ENTRY AND SUBMISSION OF THIS INFORMATION TO FUNCTION AS A LEGAL SIGNATURE. SUBMISSION OF THIS APPLICATION ALSO ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND WILLINGNESS TO PAY GPA INVOICES IN ACCORDANCE WITH THE TERMS OUTLINED IN THE CURRENT GEORGIA PORTS AUTHORITY (GPA) TERMINAL TARIFF BELOW.

RULE 34-001: APPLICATION OF TARIFF (C)
RULE 34-010: CONSENT TO THE TERMS OF THE TARIFF
RULE 34-025: CHARGES FOR EQUIPMENT, LABOR AND MATERIALS (C)
RULE 34-030: COLLECTION OF CHARGES IN ADVANCE
RULE 34-040: DELINQUENT LIST (C)
RULE 34-095: PAYMENT OF CHARGES AND INVOICES (C)
RULE 34-245: REQUIREMENT OF DELIVERY ORDER/SHIPPING INSTRUCTIONS

IN ORDER FOR GPA TO PROCESS THIS CREDIT APPLICATION, THE APPLICANT MUST ENTER HIS/HER NAME AND TITLE, FOLLOWED BY THE NAME OF THE CORPORATION, PARTNERSHIP, OR OTHER ENTITY.

 

Submitted by: * Title: *

Email: *

Name of Corporation, Partnership or Other: *