Forms Catalog - Accreditation

Re-designation Form for Carriers

arc

Introduction

This Form is used to re-designate your organization's administrator for ARC products and service (ARC Tools) such as My ARC and Document Retrieval Service (DRS).

Please Note: ARC's expects that many ARC Tools will become accessible via My ARC in the future. ARC will notify you when a Tool becomes accessible via My ARC and, at that time your organization's My ARC Primary Administrator will handle administrative functions for the tool.

Part A - Carrier Information

Please complete the required Carrier information.

Which tool administrator(s) are you re-designating? (Select at least one)

My ARC
DRS

* Complete the applicable sections of Part B for the applications selected above.

Part C - Certification

By the signature of its authorized Representative (Principal*) below, Carrier hereby certifies that the information provided herein is true and accurate and that the Carrier Representative signing on its behalf is authorized to execute this Re-designation Form on its behalf and to legally bind the Carrier.

AGREED TO BY:

Carrier Legal Name:  
Signature:  
Print Name:  
Title:  
Date:  

By signing above, I certify that I am authorized to sign this Application on behalf of the Carrier named above.

*Principal means the person who is authorized to designate the Primary Administrator on behalf of the Carrier. For a Carrier that is a U.S. corporation, the signature of a Vice President or above is required. For a Carrier that is not a U.S. corporation, the signature of a Vice President or equivalent is required, or alternatively, the signature of the highest senior level official in the U.S

ARC will endeavor to complete the requested change within 4 business days of receipt of an accurate and complete form. If a re-designation is needed on an expedited basis, please contact ARC's Carrier Help Desk with such request.

Confirmation of the re-designation will be sent to your organization's authorized location. The re-designated Administrator will have the capability to perform all administrative functions relating to your organization's use of the applicable ARC Tools.

Where to send the Completed Form

Please forward the completed and signed original form to:

ARC Attn: ARC's Carrier Help Desk
3000 Wilson Boulevard, Suite 300
Arlington, VA 22201-3862

Or you may fax the completed form to +1 703.341.1227.

Questions or Assistance

If you have any questions about how to complete the Re-designation Form, please contact the ARC Carrier Help Desk at chd@arccorp.com or call +1 855.816.8007.