BIPAD Inc. 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 $350 3 $700 5 $1000 11-15 $2250
2 $500 4 $800 6-10 $1500 16-20 $3000

* Multiple number fee rates are not retroactive and are available only at time of original application.

Effective February 1, 2014

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 by Fax to 508-819-4926 or scan and send with an email to info@nscopy.com Phone: 401 213-6830.

   


BIPAD Inc. provides the administration of a uniform and non-discriminatory number coding system for

magazines and other periodicals.
Management services are provided for BIPAD Inc. by Harrington Associates, LLC.