Add Agent Request
Add Canadian Agent Request
Branch
Change of Location
Dual Branding
Transfer of Ownership
Required fields are marked with (*)
General Information about proposed Branch
(*)Current Agency Name:
Current Agency Name Required
(*)Current Agency Number:
Current Agency Number Required
(*)Address:
Address Required
(*)City:
City Required
(*)State/Province:
Choose State/Province
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
MX
NB
NC
ND
NE
NF
NH
NJ
NK
NM
NS
NT
NV
NY
OH
OK
ON
OR
PA
PE
QB
RI
SA
SC
SD
SS
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
(*)ZipCode/Postal Code:
Zip/Postal Code Required.
Invalid Zip/Postal Code
(*)Telephone Number:
Telephone Number Required
Invalid Telephone Number (###) ###-####
(*)FAX Number:
FAX Number Required
Invalid FAX Number (###) ###-####
(*)Federal ID Number:
Federal ID Number Required
Contact Information
(*)Name:
Contact Name Required
(*)Title:
Contact Title Required
(*)Email Address:
Contact Email Required
Invalid Email (Example: John.Doe@Sirva.com)
Branch Information
(*)Will proposed branch be separately incorporated?
Yes
No
(*)What is the approximate date for branch establishment (mm/dd/yyyy)?
Date Required
List the full names of branch owner(s)/manager(s).
(*)Name
(*)Title
(*)Percentage of Share
Owner Name Required
Owner Title Required
Owner Percentage of Share Required
New Facility Information
Warehouse Street Address:
Square feet devoted to household goods:
Type of Storage?
Loose
Vault
If Vault Storage, how many high?
Dock
Yes
No
Climate Control
Yes
No
Security System
Yes
No
Sprinkler System
Yes
No
Military Approved
Yes
No
New Equipment Information
List the number of all Motor Vehicles to be used in Operations.
(*)Tractors
Number of Tractors Required
(*)Trailers
Number of Trailers Required
(*)Straight Trucks
Number of Straight Trucks Required
(*)Pack Vans
Number of Pack Vans Required
Strategy
(*)Please explain the strategic importance of the proposed new branch.
Company Strategy Required
Future
(*)Please fill out the prior three year linehaul history and the next three year business plan for interstate booking. Enter linehaul in nearest thousand dollars.
Three Year Net Linehaul Projection
Third Prior Full Year Actual
Second Prior Full Year Actual
Latest Prior Full Year Actual
First Full Year Affiliation Forecast
Second Full Year Affiliation Forecast
Third Full Year Affiliation Forecast
National Account
Prev Year Amount Required
Invalid Number
1st Year Amount Required
Invalid Number
2nd Year Amount Required
Invalid Number
3rd Year Amount Required
Invalid Number
4th Year Amount Required
Invalid Number
5th Year Amount Required
Invalid Number
Consumer
Prev Year Amount Required
Invalid Number
1st Year Amount Required
Invalid Number
2nd Year Amount Required
Invalid Number
3rd Year Amount Required
Invalid Number
4th Year Amount Required
Invalid Number
5th Year Amount Required
Invalid Number
Mil/Gov
Prev Year Amount Required
Invalid Number
1st Year Amount Required
Invalid Number
2nd Year Amount Required
Invalid Number
3rd Year Amount Required
Invalid Number
4th Year Amount Required
Invalid Number
5th Year Amount Required
Invalid Number
Total
Additional Investment Projection
Yellow Pages
Prev Year Amount Required
Invalid Number
1st Year Amount Required
Invalid Number
2nd Year Amount Required
Invalid Number
3rd Year Amount Required
Invalid Number
4th Year Amount Required
Invalid Number
5th Year Amount Required
Invalid Number
Sales Staff
Prev Year Amount Required
Invalid Number
1st Year Amount Required
Invalid Number
2nd Year Amount Required
Invalid Number
3rd Year Amount Required
Invalid Number
4th Year Amount Required
Invalid Number
5th Year Amount Required
Invalid Number
Additional Marketing
Prev Year Amount Required
Invalid Number
1st Year Amount Required
Invalid Number
2nd Year Amount Required
Invalid Number
3rd Year Amount Required
Invalid Number
4th Year Amount Required
Invalid Number
5th Year Amount Required
Invalid Number
Equipment Purchase
Prev Year Amount Required
Invalid Number
1st Year Amount Required
Invalid Number
2nd Year Amount Required
Invalid Number
3rd Year Amount Required
Invalid Number
4th Year Amount Required
Invalid Number
5th Year Amount Required
Invalid Number
Painting/Refurbishing
Prev Year Amount Required
Invalid Number
1st Year Amount Required
Invalid Number
2nd Year Amount Required
Invalid Number
3rd Year Amount Required
Invalid Number
4th Year Amount Required
Invalid Number
5th Year Amount Required
Invalid Number
Other
Prev Year Amount Required
Invalid Number
1st Year Amount Required
Invalid Number
2nd Year Amount Required
Invalid Number
3rd Year Amount Required
Invalid Number
4th Year Amount Required
Invalid Number
5th Year Amount Required
Invalid Number
Total
Growth
Year 1
Year 2
Year 3
Year 4
Year 5
Average Growth
Revenue
Click Update to calculate Totals and Revenue Growth
The undersigned hereby authorizes Allied Van Lines, Inc.(AVL) to investigate the veracity of statements contained in this Agency Application, as part of AVL's procedure for processing said applications. The undersigned further agrees to hold harmless all persons and companies from whom AVL may seek, in good faith, information about the Undersigned Company and management thereof, which will assist AVL with respect to the application. The undersigned hereby makes and gives AVL and said person and companies full release and discharge to all damages, claims and injuries of any kind resulting from said disclosures so long as the disclosures are made in good faith and reasonably related to the agency application, and the purpose of the use thereof is solely related to the determination of fitness as an agent for AVL. The undersigned further understands that it has the right to make a written request within a reasonable period of time for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation.
By signing below applicant certifies that all information contained in this application is accurate and complete to the best of his knowledge. Applicant further acknowledges that AVL will rely on the information in this application in deciding whether to offer an agency contract to applicant and that, therefore, should AVL determine that the information contained herein is materially incorrect or incomplete that Allied may reject this application or, if previously granted, may terminate applicant's agency contract with AVL. Finally, applicant acknowledges that the decision as to whether AVL approves this application is solely within its discretion.
(*)Name of Applicant:
Name of Applicant Required
PLEASE SAVE AND PRINT A COPY OF THIS APPLICATION FOR YOUR OWN RECORDS BEFORE SUBMITTING.
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