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FORM 604 CHANGE OF SATELLITE TICKET PRINTER (STP) LOCATION



FORM 604 CHANGE OF SATELLITE TICKET PRINTER
(STP) LOCATION

12/31/07 2:13 PM REV 12/07 VER 8.6
1
PREPARER INFORMATION

ALL CORRESPONDENCE REGARDING THIS APPLICATION WILL BE SENT TO:


1. Name of preparer:


First
________________________
MN
________________
Last
_____________________________________

2. Doing business as _____________________________________________________________________
(dba) name:

3. Suite, floor,
_____________________________________________________________________
or P. O. box:

4. Street address:
_____________________________________________________________________

5. City: _________________________________________ State: ______ Zip: _________________________

6. Telephone number: ________________________________________

7. Fax number:
________________________________________

8. E-mail address:
____________________________________________________________________


PART 1. CURRENT STP AND HOST OFFICE INFORMATION


A. CURRENT STP LEGAL NAME AND ADDRESS


1. STP ARC code number: _________________________


2. Legal Name: ____________________________________________________________________

3. Doing business as (dba) Name: ______________________________________________________

4. Suite: ____________ Floor: ____________ P O box:____________


5. Street address: _________________________________________________________________

6. City: _______________________________ State: _______________________ Zip: ____________

7. STP telephone number: _________________________

8. STP fax number:
_________________________




B. CURRENT HOST INFORMATION


Host ARC code number: _____________________________






FORM 604 CHANGE OF SATELLITE TICKET PRINTER
(STP) LOCATION

12/31/07 2:13 PM REV 12/07 VER 8.6
2
PART 2. NEW STP INFORMATION


A. NEW STP DBA


1. Will the STP (DBA) name be changing as a result of this relocation?
YES
NO


a) If Yes, list the new (DBA) name: _______________________________________________


B. NEW STP ADDRESS


1. Suite: _____________ Floor: _____________ P.O. box: _____________



2. Street address: ______________________________________________________________


3. City: ___________________________ State: __________________ Zip: _________________



4. STP telephone number: _________________________


5. STP fax number: _________________________


C. REDESIGNATION OF HOST


1. Will the ARC authorized location from which the STP location is
YES
NO
currently remoted (the host) be changing as a result of relocating the STP?

2. If Yes, list new ARC code number: _________________________

3. Legal name: _______________________________________________________________

4. Doing business as (dba) name: ________________________________________________

5. Suite: _____________ Floor: _____________ P.O. box: ______________

6. Street address: _____________________________________________________________

7. City: __________________________ State: ____________________ Zip: _______________

8. Host office telephone number: ________________________

9. Host office fax number: _____________________________



D. NEW SALES SUMMARY ADDRESS

State the address to which sales summaries should be mailed upon completion of the change of location:

1. Suite: ____________ Floor: _____________ P.O. box: _____________

2. Street address: _______________________________________________________________

3. City: _______________________ State: _____________________ Zip:__________________











FORM 604 CHANGE OF SATELLITE TICKET PRINTER
(STP) LOCATION

12/31/07 2:13 PM REV 12/07 VER 8.6
3


E. ADDRESS FOR AGENCY CORRESPONDENCE


Provide the address to which all mail other than sales summaries should be mailed:

1. Suite: ____________ Floor: _____________ P O. box: ______________

2. Street address: ________________________________________________________________

3. City: ________________________ State:_________________ Zip: ______________________


F. TICKET DELIVERY ADDRESS

Provide the authorized street address to which ARC traffic documents will be delivered. ARC traffic documents will not
be delivered to a P.O. Box or a STP location.

1. Suite or floor: _____________________

2. Street address: _________________________________________________________________

3. City: ______________________ State: ___________________ Zip: _____________________

4. ARC number of the above location (if applicable): ___________________________


G. APPLICATION TYPE



Select one application type from the list below:




Type 1 Attended: in private area, will NOT serve general public



Type 2 Attended: in secure common area; may serve general public



Type 3 Unattended: private area business hour use; will NOT serve general public



Type 4 Unattended: secure common area 24-hour use, will NOT serve general public



Type 5 Unattended: general public business hour use



Type 6 Unattended: general public 24-hour use


PART 3. STP PREMISES AND ACCESSIBILITY


A. PREMISES OF STP

1. Describe the building or facility where the STP is located:

Single/multi-user commercial office bldg

Bank
Within another business



Airport
Separate retail store front



Hotel
Military or Government office
If other, describe:

2. Is the applicant located on the premises of an ARC approved entity?



YES NO

If Yes:

a) List ACN of accredited entity: ___________________________

b) Legal Name: ________________________________________




FORM 604 CHANGE OF SATELLITE TICKET PRINTER
(STP) LOCATION

12/31/07 2:13 PM REV 12/07 VER 8.6
4


B. PRIVATE RESIDENCE


1. Is the STP located in a residence?















YES
NO


2. If Yes, does the proposed STP location have the requisite







YES
NO


licenses of the jurisdiction in which it is located?


C. OPEN TO THE PUBLIC


1. Is the STP location regularly open to the general public?








YES
NO


D. ACCESS TO STP

How is unauthorized access to the actual STP restricted? (CHECK AS MANY AS APPLY)



gain clearance from a security guard or receptionist secure a visitors pass


show identification









be escorted


announce arrival to a receptionist




be authorized entry by phone


register upon entry
enter through a gate

not restricted


other - comply with other security arrangements not listed above



If other describe: _______________________________________

PART 4. SCOPE OF OPERATIONS

A. CLIENT(S) OF STP

1. What type of client(s) will the STP serve? (Check as many as apply):

One commercial account exclusively
Employee leisure travel

Multiple commercial accounts

Visitor and/or general public

Other: describe: _____________________________________________

2. Provide the name of the primary customer or client for this proposed STP location:

Name of customer or client: _________________________________________

3. Describe the nature of the customer/clients business: ______________________

________________________________________________________________

B.
ADVERTISEMENT

1. Will the STP location be advertised?
YES
NO

a) If Yes, check as many as apply:

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