Service Provider Application

Contact Information
Company Name:*
Contact Name:
Street Address:
City:
State:
Zipcode:
Phone:*
Cell Phone:
Fax:
Email:*
Website:
Company Information
Fein #:
Number of Employees:
Number of Trucks:
Van Line Affiliation:
Insurance Information
Worker's Comp Insurance?
Worker's Comp Certification:
Max. file size: 256 MB.
Please upload a copy of your Workers Compensation Certificate.
General Liability Insurance?
General Liability Certification:
Max. file size: 256 MB.
Please Upload a Copy of Your General Liability Certification:
Experience
Do You Have Experience Loading Portable Storage Containers:
Do You Keep Packing Materials On Hand?
Do You Have Paper Pads (Used for Military & International Shipments)?
Are You Military Approved?
Are Your Crews Familiar With These Procedures?
- Grand Piano
- Crating
(Please Check All That Apply)
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Name
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If you are interested in becoming a service provider for Pack and Load, please fill out the application below.