Registration Form

Basic Info
Contact Details
Physical Location
Mailing Address
Repair Facility Details
Attach W9*
Office Hours
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Preferred Network Status (please update the below rates that you are willing to provide to Sedgwick customers)
Posted Rates (Normal Rates) Preferred Network status rate (Sedgwick Customer Rates)
Body*
$
$
Paint*
$
$
Mechanical*
$
$
Training and Certification
Additional Equipment and Services
Additional Comments
Images

Image of the front of your repair facility*

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Internal picture of your lobby and internal shop*

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