For Service Providers Service Provider FormPlease enable JavaScript in your browser to complete this form.1234First, we'd like to learn a little about who you are.Please tell us a bit about yourself.Name *FirstLastWhat is your position at your company *OwnerBookkeeper/ AccountantAdministrative SupportSchedulerOtherPlease tell us a bit about your companyWhat is the name of your company? *What is your company's address? *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWho is the contact person at your company? *What is your company's phone number? *What is your company email address or the best email address to contact your company? *NextSecond, we'd like to learn a little about your company.Please tell us a bit about how you operate.Please tell us a bit about your service areaWhat is the market name of your primary service area? *(For example: Northern Indiana)What is the zip code of your primary service area? *Please enter 5 digits of your zip codePlease select the farthest distance beyond your primary zip code that you service *No more than 10 milesNo more than 20 milesNo more than 30 milesNo more than 40 milesNo more than 50 milesBackNextThird, we'd like to learn a little about your technicians and the technology they use.Please tell us a bit about your technicians.What type(s) of screening do you perform on each of your technicians? *Background InvestigationDrug ScreeningBoth Background & DrugNeither background nor drugDo your technicians wear uniforms ? *YesNoAre your trucks labeled? *YesNoWhat percentage of your technicians are employed as?Total of your answers should be equal to 100% (You do not need to enter a % sign.)Direct employees *Sub-contractors *Total *Total value should be equal to 100.How many of your technicians provide in-home service? *Enter a numberPlease tell us a bit about the technologies your technicians useWhat percentage of your technicians use smart phones on the job?100%More than 50%Less than 50%NoneWhat percentage of your technicians use tablets on the job?100%More than 50%Less than 50%NoneBackNextFourth, we'd like to learn a little about your services and how you heard of us.Please tell us some specifics about your servicesWhat is your standard labor rate for your service area per call?Between $0 and $50Between $51 and $75Between $76 and $100Between $101 and $175OtherWhat is your company's approximate division of in-home service repair volume by type?The total of your answers should be equal to 100% (You do not need to enter a % sign.)Cash on Delivery *In-Warranty *Extended service contract *Delivery and installation *TotalTotal value should be equal to 100.What percentage of your technicians use laptops on the job?100%More than 50%Less than 50%NoneIs your company able to maintain at least $1 million in general liability insurance for your Technicians at all times?YesNoPlease tell us how you heard about usHow did you learn about the Asurion network? *Referred by someoneSocial MediaTrade showOtherWere you previously a part of the Asurion networkYesNoEmailSubmit