NEW JERSEY MOVERS TARIFF BUREAU, INC



NEW JERSEY MOVERS TARIFF BUREAU, INC. (NJMTB)

APPLICATION FOR TARIFF MEMBERSHIP (For a Licensed Mover)

Applicant Trade Name (DBA):___________________________________________Date:___________________

Corporation Name______________________________ Date of Inc__________ FEID#______________________

Address:________________________________ City:_____________________ State:_______ Zip:___________

County:______________ Phone:_______________ Fax:_______________ Email:__________________________

Company Officer:________________________ Title:____________________ NJ Movers License #:___________

Company Officer:________________________ Title:____________________

( ) Household Goods ( ) Local Moving ( ) Long Distance Moving ( ) Storage

( ) Other Services _____________________________________________________

Number of Moving Vans ____ Tractors:___ Trailers:____ Stg. Space for Household Goods ____________sq ft Type of Storage offered: Palletized _____ Containerized ______ Loose Stacked:_____ General Commodities__________________

Van Line Affiliation _____________________________________ US DOT No._________________

Please review the following instructions prior to mailing your application. Return the application with the following documents: (This application is subject to review by the NJ Movers Tariff Bureau Executive Board.)

Copy of Movers License, certificate of Incorporation and NJ Business Registration. Annual FEES: $375.00

As long as the participant is using the NJMTB Copyrighted Tariff, the fee is due yearly, whether or not changes are made to the existing tariff. If your tariff is cancelled, it is your responsibility to file a new tariff in a different format with the NJ Division of Consumers Affairs or your mover’s license may be suspended. You are prohibited from copying our format.

Upon receipt of your completed Power of Attorney Form, Certificate of NJ Business Registration, copy of your NJ mover’s license and appropriate fee, NJMTB will publish your requested rates in the agency tariff. Upon receipt of your copy of the tariff, review the information and advise any discrepancies immediately to the Tariff Office. We do not offer legal advice.

IMPORTANT NOTE: Improperly filled out or incomplete forms will be returned to you and will delay your membership in the Tariff Bureau. Forms submitted without payment will be returned for payment. If you have any questions regarding the proper completion of either of the forms or the proper amount, call the Tariff Bureau Office for assistance. 732-341-3934. Please either print or type the forms. We are not liable for penalties caused by delays or unintentional acts or omissions.

We would like the NJ Movers Tariff Bureau, to send us facsimiles or emails, including seminar information, promotional materials, advertising, including material that may originate from an industry affiliate such as AMSA or NJWMA.

Sign here if you wish to receive faxes & emails. Signature______________________________

NOTICE: This is an application for the Tariff Bureau; it is not an application for membership in the NJWMA,

You are not required to use our tariff to obtain a NJ Public Mover's license, you can write your own tariff.

If you join the Tariff Bureau, You are not allowed to use the NJWMA or COE logos unless you also apply for membership with NJWMA. If your membership in NJ Movers Tariff Bureau is discontinued for any reason whatsoever, the copyrighted tariff sent to you will be CANCELLED and it must be returned to the NJMTB office immediately. You are PROHIBITED from using our format or any part of our tariff. We are required to notify NJ Consumer Affairs that you have cancelled your filed tariff and you must write your own tariff and re-file a tariff with the Division of Consumer Affairs

Credit card authorization: Please charge my annual fee to my credit card; Card#____________________________ Exp_____

Amount of Fee: $_______________ Check number received: ________ (or) Type of Credit Card______________________

I accept all of the above terms; SIGNATURE: _____________________________ Name Printed_____________________ revised 5/6/09

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