NEW MEMBERSHIP APPLICATION

​

Company name:  ______________________________________________________________

Address: _____________________________________________________________________

Main phone # __________________________ Website: _______________________________

Social media in use: ____________________________________________________________

Membership level/company size:  __________________________________________________

Primary contact: ________________________________

Title: ___________________________

Phone # ______________________________

Email: ___________________________________

Secondary contact: _________________________________

Title: ________________________ Phone # ______________________________

Email: ___________________________________

Would you like to be added to our open-access corporate directory? y/n __________________

Would you like to be added to our members-only information boards & services? y/n ________

Would you like to be publicly acknowledged as a member of IMBA? y/n __________________

What services or products does your company offer in the marine sector? ______________________________________________________________________________ ______________________________________________________________________________

Please note that signing up for membership gives us permission to use your email to communicate with you and your firm.

IMBA will NOT share your information with anyone other than by listing your corporate details as authorized above.

Signature: ___________________________________________ Date: _____________________ ______________________________________________________________________________

Internal IMBA use only: Date accepted: _________________

Authorized by: ___________________________________

​

​

​

​

​

Our bank details:

​

Payments in EUR /  Перекази у Євро

Currency: EUR

59: Beneficiary Customer

IBAN: UA343281680000026008000004367

Receiver: IMBA

57a: Account With Institution

Bank: MTB BANK

SWIFT/BIC MTBAUA2D

Adress: 11 Polskiy Spusk, 65026 Odessa Ukraine

56a: Intermediary (Correspondent bank)

Bank: OTP BANK PLC.

City: Budapest, Hungary

Correspondent Account Number: 11782007-21233872

SWIFT/BIC: OTPVHUHB

Payments in USD /  Перекази в доларах США

Currency: USD

59: Beneficiary Customer

IBAN: UA163281680000026009000004366

Receiver: IMBA

57a: Account With Institution

Bank: MTB BANK

SWIFT/BIC: MTBAUA2D

Adress: 11 Polskiy Spusk, 65026 Odessa Ukraine

56a: Intermediary (Correspondent bank)

Bank: JOINT STOCK COMPANY 'THE STATE EXPORT-IMPORT BANK OF UKRAINE'

City: Ukraine, Kyiv

Correspondent Account Number: UA273223130000016009012153737

SWIFT/BIC: EXBSUAUX

​