COVAN WORLD-WIDE MOVING, INC. AGENCY APPLICATION
Legal Name:		D/B/A:
Physical Address:		County:
City:		State:	Zip:
Mailing Address:		City: State: Zip:
Phone Number:		Fax:
Federal ID #:		E-Mail Address:
Military Approved?	Yes No	Installtions Represented:
Hours of Operation		After Hours Contact:
Phone		Warehouse Capacity SF:
Military Approved:	Yes No	Type Construction:
Type Storage:		Loading Dock?	Yes No
Name / Address of closest certified scale:

HAULING INFORMATION
Do you have the capacity to self-haul? Yes No
Number of Tractors		Trailers		Straight Trucks		Pack Vans
Do you haul under your own authorithy? Yes No ICC #
If NO, whose authority do you haul under?					ICC #
Number of drivers? Long Haul				Short Haul
Do you want to receive our available tonnage list?				Yes No
Can you perform containerized / lift van service?				Yes No

PAST AFFILIATIONS
List below carrier affiliations:
(1) Name	Address	Dates to/from
Reason for discontinuing:
(2) Name	Address	Dates to/from
Reason for discontinuing:

PRESENT AFFILIATIONS
List below all present carrier affiliations (Including Military)
Firm Name		Address
Firm Name		Address
Firm Name		Address
CERTIFICATION
By clicking the submit button below, I certify that I am an Officer or Owner of the above described Company, certify that the foregoing information is true and correct to the best of my knowledge, and has been taken from the books, records, and files of said company.
Covan World-Wide Moving, Inc, /Coleman American Moving Services, Inc, is committed to equal opportunity in vendor selection, employment and service and does not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or citizenship or veteran status as provided by law. We comply with all applicable non-discrimination and affirmative action provisions provided under applicable regulation and by law. We expect all sub-contractors and vendors to adhere to all state and federal laws and/or other regulations relating to equal employment opportunity, affirmative action and those prohibiting discrimination.