Boat Transport Company Profile

---

  Print and Mail or Fax this Form

$150 (US) for 3 full months, pre-paid orders $250. for 6 months, $500. for 1 year.
Master Card / Visa, Company Check by fax. Photo copy your check and fax to
561-451-4243 Made payable toCrown Eagle, Inc.

Amount of: $150 for 3 months: __ $250 for 6 months: __ $500 for 1 year: __

Credit Card information
(Please Note: There is a 5% processing fee for all credit card information)

Card Name: .........Master Card ___ Visa ___

Account #: ________________________________________ Expiration Date ________

Cardholder Name: (print name) ___________________ Signature: _________________________

Please Note: Your order will be processed by AIM Marketing Their name will appear onyour credit card billing statement for yhe amount of this purchase.
($20 fee will be charged for re-processing of charge backs)

Company Name: ________________________

Address: __________________________ City: _________________ State: ____Zip: ___________

Business Address: ____________________ City: _____________ State: ___ Zip: _________

Phone: ______________ Fax: __________________ E-mail: ___________________

Other: __________________

CDL Class: _________ Endorsement (s): _____________________________________________

Authority Information: ____________________________________________________________

Insurance Information: _______________________________________________

Truck (s): Year: ____ Make: ____________ Model: ______ Trailer (s): Year ___ Make___________

Tractor (s): Year: _____ Make: ____________ Model: _______ Trailer (s): Year ____ Make:________

Load Capabilities: Maximum: _______________ Desired Areas of Operation: All 48 states: __
North __ South __ East __ West __

Eastern seaboard: __ Southeast: __ Mid-Atlantic: __ New England __

Midwest __ South Central __ North Central __ Southwest __ Northwest __

Central Mountain __ West Coast __