For Service Providers

First, we'd like to learn a little about who you are.

Please tell us a bit about yourself.

Name *

First

Last

What is your position at your company *

Please tell us a bit about your company

What is the name of your company? *

What is your company's address? *

Address Line 1

Address Line 2

City

State

Zip Code

Who is the contact person at your company? *

What is your company's phone number? *

Please enter 10 digits of your phone number

What is your company email address or the best email address to contact your company? *

Second, 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 area

What 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 code

Please select the farthest distance beyond your primary zip code that you service *

Third, 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? *

Do your technicians wear uniforms ? *

Are your trucks labeled? *

What 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 number

Please tell us a bit about the technologies your technicians use

What percentage of your technicians use smart phones on the job?

What percentage of your technicians use tablets on the job?

Fourth, we'd like to learn a little about your services and how you heard of us.

Please tell us some specifics about your services

What is your standard labor rate for your service area per call?

What 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 *

Total

Total value should be equal to 100.

What percentage of your technicians use laptops on the job?

Is your company able to maintain at least $1 million in general liability insurance for your Technicians at all times?

Yes
No

Please tell us how you heard about us

How did you learn about the Asurion network? *

Were you previously a part of the Asurion network

Yes
No