Independent Contractor Application

Independent Contractor Application
Contact Information
Your Name *

First Name Last Name
Company Name
Are you Incorporated?

YES NO
Address

Street Address

Street Address Line 2

City State

Zip Code
Your E-mail Address
Business Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
Do you use WiFi in the field?

YES NO
Smartphone?

iPhone Android Windows/Other No Smartphone
Work History, Experience, and Coverage Area
Can you pass a federal background check?

YES NO
Are you a fully licensed appraiser in your state?

YES NO Not Applicable
What cities, counties, or states do you cover? *
What estimating skills do you have? Check all that apply.

Automobiles/ Light Truck Classic or Exotic Vehicles Recreational Vehicles Motorcycles Heavy Equiptment Tractor/ Trailer (ORTT) Property Other
Do you have 5 combined years of related estimating experience (body shop, insurance company, etc):

YES NO
What estimating systems do you have proficiency in using?

Audatex CCC Property Estimatics Mitchell TruckEst / TruckWriter Other
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