Agents

First Name: *
Last Name: *
Address 1: *
Address 2:
City: *
State: *
Zip Code: *
Phone: *
Email: *
When can you start?	Ex. 07/15/2009
How did you hear about MILLER? *
If other:
Are you experienced working as a transportation broker? *
If Yes, for how long?
Are you currently working as a transportation broker: *
If Yes, for how long?
Are you currently under contract as a broker agent with another company? *
If Yes, please provide company name:
Do you have your own authority? *
Do you have an established customer base? *
If yes, how many?
Do you have a reliable carrier following? *
How many loads, on average, do you currently book per week? *
Do you have a target market? *
Please provide examples of the types of products you currently handle for your customers. *
What strategy will you use to market your services and ours? *
Cover Letter: Please use this area to provide additional qualifications or comments. *

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