NS Copy Application Form

BIPAD	E-Mail Application Form BIPAD Magazine Periodical Publication Title Number

IMPORTANT! Please read the information on www.bipad.com very carefully to insure that you do need a BIPAD number and how many you need. We are not able to issue refunds once a number has been assigned since there is no way for us to recover numbers confidently.

* = Required Fields

* Publishing Company Name:

* Street Address:

* City:

* State/Province:

* ZIP/Postal Code:

PO Box:

City:

State/Province:

ZIP/Postal Code:

* Phone:

(Just numbers. No hyphens or spaces)

Fax:

(Just numbers. No hyphens or spaces)

* E-Mail:

Website Address:

* Name of Key Contact:

Has the company previously been assigned BIPAD numbers(s)? Yes No

If Yes, the number(s) is (are)

Does the company have a "GSI" or "Uniform Code Council" (UCC) Company Prefix number? Yes No

If Yes, the number(s) is:

Number of titles for which BIPAD numbers are to be allotted . (A different BIPAD number must be used with each title publication for which separate distribution records are to be maintained by wholesalers. It is not necessary to obtain a different BIPAD number for each issue.)

Credit Card Type:

Credit Card Number:

Name (as appears on credit card):

Expiration Date (month/year):

CCV Code:

**Please note: This charge will be under the name of HARRINGTON ASSOCIATES on your statement.

FEE SCHEDULE *
BIPAD Numbers	Fee	BIPAD Numbers	Fee	BIPAD Numbers	Fee	BIPAD Numbers	Fee
1	$375	3	$750	5	$1000	11-15	$2625
2	$550	4	$900	6-10	$1750	16-20	$3500
* Multiple number fee rates are not retroactive and are available only at time of original application.

Effective February 1, 2022

NAME OF TITLES (A different BIPAD number is required for each title, but not for each issus.	ISSUE FREQUENCY

NUMBER OF MAGAZINE WHOLESALERS:
NAME OF MAGAZINE WHOLESALERS/DISTRIBUTORS	LOCATION CITY	STATE


*Enter Security Text From Above :**

If you have trouble using the online form or do not receive an email confirmation, please feel free to submit your request using the PDF format scan and send with an email to info@nscopy.com

BIPAD provides the administration of a uniform and non-discriminatory number coding system for magazines and other periodicals. Management services are provided for BIPAD by Harrington Associates, LLC.