CBP Form 3124: Application for Customs Broker License

Enter the Applicant's Name and Address (Principal Office) in Box 1: Name, Street Address, City, State and Zip.

In Box 2, Type of License Applied For, mark LLP, LLC, Corporation, Partnership or Association.

Enter the CBP Port in Box 3.

Submit application and all additional continuation sheets, if required, to the processing Center Broker Management Officer located at the Port named in Block 3.

Box 4: Has the organization ever applied for a customs broker's license? Mark No, or mark Yes and explain in Box 7.

Box 5: Has the applicant (or any officer, member, or principal there of as identified in Block 22) ever had a license suspended, refused, revoked, or cancelled? Mark No, or mark Yes and explain in Box 7.

Box 6: Is the applicant (or any officer, member or principal thereof as identified in Block 22) an officer or employee of the United States? Mark No, or mark Yes and explain in Box 7.

In Box 7 Remarks, in responding to questions above, include Block no. If more space is needed continue on blank sheet of paper.

For association, corporation, LLC, partnership, or LLP, enter the Date Applicant Was Organized in Box 8 and the State Where Organized in Box 9.

Box 10 Attachments lists: Copy of articles of incorporation or association; Evidence of the partnership (copy of the articles of agreement or affidavit signed by all partners).

In Box 11, list the names, addresses, titles, and dates and places of birth of all officers of the association or corporation, and all principals who have a controlling interest (Example: 10% or more of stock), who hold individual customs brokers' licenses and give the general nature of duties of each, or if a partnership, list name and address of members who hold such licenses.

In Box 12, list the names, addresses, titles, and dates and places of birth of all officers and principals (including corporations, trusts, and/or other organizations) who have a controlling interest, if not listed in Block 23 (Example: 10% or more of stock), and partners who do not hold customs brokers' licenses.

Fill in Last Name, First Name, MI, Street Address, City, State, Zip, Title, Birth Location and Birth Date.

Any misstatement of pertinent facts in this application constitutes sufficient grounds for denial of the application.

The officers and partners who are licensed customs brokers are aware of the requirements for the exercise by them of responsible supervision and control of the transactions of the CBP business of the applicant.

Written notice of any change in the applicant's mailing address, name, licensed officers or partners, or the charter, certificate, articles, or other instrument of organization of the applicant will be given to the Commissioner of Customs and Border Protection.

Sign on the Signature line in Box 13 and enter the date in Box 14.