Application for Appointment

Thank you for your interest in becoming a MOVER’S CHOICE Broker. Please allow 10 business days for the review of your application.

Brokerage/Agency Name

DBA

Street Address

City

State

Zip

Phone

Website

Does your Brokerage / Agency have more than one location?
YESNO
If so, please list the cities and states of the other locations

How many years has the Agency been in business?

Total amount of premiums written by the Agency in Moving and Storage only? (Do not include Trucking, General Freight or Logistics premiums)

Can your Agency commit to a minimum premium requirement of $250K in 12 months?
YESNO

Provide names of the current Agencies and Insurance Carriers you place Moving & Storage business with:

Agency Name

Insurance Company

L.O.B.

$ Volume

Loss Ratio

List all owners of the entity (Partners, Officers, Etc.)

Name

Title

Years of Experience in Moving & Storage

How much of your business is:

Direct Bill %

Premium Financed %

Please leave this field empty.

APPLICATION FOR APPOINTMENT