Vendor Application Form

1
What is your name?* This field is required.
First Name
Last Name
2
What is your company name?* This field is required.
3
What is your email?* This field is required.
example@example.com
4
What is your phone number?* This field is required.
Please enter a valid phone number.
5
What Services do you Provide?* This field is required.check all that apply
Property Damage Inspector
Xactimate Writer Services
Claims Process Manager
Public Insurance Adjuster
Independent Insurance Adjuster
Storm Damage Contractor (Residential)
Storm Damage Contractor (Commercial)
Drone Pilot
Property Damage Attorney
Structural Engineer
Property Damage Appraiser
Claims Umpire
Property Damage Expert Consultant
Sales and Marketing Trainer
Storm Damage Restoration Training School/Instructor
Matter Port Photographer
Insurance Agent
Subject Matter Expert
6
What Areas do you Service?Add all markets you typically service. Be as broad or specific as you want. Click the + button to add more
7
How many Xactimate estimates can you handle in a weekclick next if this does not apply to your services
5 or less
More than 5
8
What areas do you service?* This field is required.
Toledo
Cleveland
Akron
Mansfield
Findley
Lima
Columbus
Dayton
Cincinnati
Marietta
Other
9
How long have you been in this industry? Please tell us about yourself and your background.
10
You will be required to sign our subcontractor agreement. This agreement can be found on our website. If you would like us to email you our agreement, please let us know and we will send it out right away.
Please send me the agreement
I already have the agreement
11
Initially, you will be emailed the details of the project, but it will not include the name or contact information of our customer. To obtain that information, you must accept the opportunity and pay the associated fee. Links to accept the opportunity and pay the invoice will be located within the email. As soon as the invoice has been paid, you will receive the client's contact information within 48 hours. This does not apply to xactimate writers or claims process managers. Do you understand?
Yes
No
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