Add Agent Request
Add Canadian Agent Request
Branch
Change of Location
Dual Branding
Transfer of Ownership
Required fields are marked with (*)
General Information
(*)Current Agency Name:
Current Agency Name Required
(*)Current Agency Number:
Current Agency Number Required
Contact Information
(*)Name:
Contact Name Required
(*)Title:
Contact Title Required
(*)Email Address:
Contact Email Required
Invalid Email (Example: John.Doe@Sirva.com)
Organizational Information
(*)What is the proposed name for the new agency?
New Agency Name Required
Type of Company
Choose Type of Company
C or S Corporation
Partnership
Individual
(*)Full Name of Owner(s)
(*)Percentage of Share
Owner Name Required
Owner Percentage of Share Required
(*)Name of Officer
(*)Title
Officer Name Required
Officer Title Required
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
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 five year business plan for interstate booking and hauling for the new branch. Enter projections in nearest thousand dollars.
Five Year Net Linehaul Projection
Previous 12 Months
First Year of Afiliation
Second Year of Affiliation
Third Year of Affiliation
Fourth Year of Affiliation
Fifth Year of Affiliation
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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