Application For Motor Carrier Certificate Before The Alabama Public Service Commission

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14H
APSC FORM NO.
DOCKET NO.
(Household Goods)
(Commission use only)
APPLICATION FOR MOTOR CARRIER CERTIFICATE
Before the
ALABAMA PUBLIC SERVICE COMMISSION
This Application should be typed or neatly printed, properly signed and sworn to, and filed with
the $100.00 filing fee (cashier’s check or money order) with the Alabama Public Service Commission, P. O.
Box 304260, Montgomery, Alabama 36130.
SECTION I
Applicant
(Legal name)
Doing Business as
(Trade name)
Business Address
(Must be a physical address – cannot be a post office box)
(City)
(State)
(Zip Code)
Mailing Address
(May be a post office box)
(City)
(State)
(Zip Code)
(
)
(
)
(Telephone Number)
(Facsimile Number)
(Email address)
Applicant seeks a Certificate to transport Households Goods between all points in the State of Alabama,
except (list any exceptions)______________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
SECTION II
FORM OF BUSINESS (Check only one):
CORPORATION
LIMITED LIABILITY COMPANY (LLC)
LIMITED PARTNERSHIP (LP)
LIMITED LIABILITY PARTNERSHIP (LLP)
SOLE PROPRIETORSHIP
PARTNERSHIP (Identify partners)
OTHER (identify)
Revised 2012
APSC Form No. 14H
-1-

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