Service Provider Application Service Provider Application Step 1 of 5 20% Contact InfoName(Required) First Last Phone(Required)Email(Required) Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I am willing to submit to a background check.(Required) Yes No Are you a solo mover or part of a team?(Required) Solo Mover Part of a move team or Move Company Your Business InformationBusiness Name Doing Business As (Optional) Primary PhoneAlternate PhoneBusiness Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you carry business insurance?(Required) Yes No Do you carry a valid business license?(Required) Yes No If approved you will be asked for your license number.Are you a licensed full-service mover?(Required) Yes No How many years of experience do you have?(Required) How many crew members do you have?(Required) Do your crew members wear uniforms or matching shirts while on moves?(Required) Yes No Do you have a website?(Required) Yes No What is the web address? Are you able to provide packing services and supplies if needed? ie. shrink wrap, boxes, tape, tie downs, etc. ?(Required) Yes No Are you able to bring a moving dolly and a basic set of tools to every move?(Required) Yes No Are you able to perform moves on military bases?(Required) Yes No Are you able to move Upright or Spinet piano?(Required) Yes No Are you able to move gun safes that are 500 lbs or less?(Required) Yes No How far are you willing to travel to perform a move? Serivce Prodiver Terms & ConditionsPlease Upload a photo of the FRONT of your Drivers Liscence(Required)Max. file size: 256 MB.Please Upload a photo of the BACK of your Drivers Liscence(Required)Max. file size: 256 MB.Tell us more about yourself/your team..SERVICE PROVDER TERMS & CONDITIONS(Required) I agree to MLHC Service Provider Terms & ConditionsView Terms & Conditions
