The CEI Direct Repair Network™ Application

Business Data

Name of business: (Trading as)

Coporate name (if any):

Telephone:

Fax #

Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of nearest major city:

Shop hours M-F:

Shop hours SAT:

President (If a corporation):

Owner's name (if not a corporation):

Tax ID#

Tax ID or S.S. #

Do you currently hold any state appraiser's licenses?

Yes
No

How many

What states

Shop Profile

Shop size in Sq. Ft.

Total number of employees:

# Paint techs:

# Metal/Frame techs:

Name of manager:

Annual Volume

Computer Equipment:

1 PC
2 PC
2 or more PC's & Servers

Computerized estimating system:

Internet Access:

Always online
Daily
Weekly

Paint facilities:

Room
Booth

Make:

Downdraft

Yes
No

What brand of paint do you use?

Digital photos available

Yes
No

Upload Here (or email membership@ceinetwork.com):

Drop files here or

What frame equipment is used in the shop?

How Many?

Type

Unibody rack
Bench
Quadri-clamp
Other

Please name Type:

Storage Lot

Yes
No

Enclosed

Yes
No

Mechanical repair on premises

Yes
No

Do you have towing equipment

Yes
No

Night tow number

Pick-up & delivery services

Yes
No

What specialty work is done at your shop

How many staff members at your shop are ICAR certified?

Is the owner certified?

Yes
No

Is the manager certified?

Yes
No

Do you participate with insurance and fleet Direct Repair Networks?

Yes
No

Please provide the name, the number of years, the labor and parts discounts you offer to them:

Provide Name | Years | Labor rate discount | Parts discount

Garage Keeper's Liability Insurance Information

Name of insurance company:

Policy number and effective dates:

Name and address of insurance broker:

Phone Number

Fax Number:

Name:

Date:

Upload Insurance Certificate Here (or email membership@ceinetwork.com):

Drop files here or

IF YOU HANDLE MEDIUM TO HEAVY DUTY TRUCKS PLEASE COMPLETE

Do you handle truck collision repairs?

Yes
No

Shop ceiling and door height:

Can you perform repairs of truck boxes?

Yes
No

Do you have truck towing equipment?

Yes
No

Can you handle truck mechanical repairs?

Yes
No

What type of mechanical repairs?

Do you have the capability to repair and replace Hydraulic lift gates?

Yes
No

Buckets?

Yes
No

Hydraulic bucket lifts?

Yes
No

Can you repair Tractors?

Yes
No

Trailers?

Yes
No

Do you have truck frame equipment?

Yes
No

Type:

Do you have a frame shop to sublet to?

Yes
No

Do you have truck alignment equipment?

Yes
No

Type:

Types of trucks repaired & percentage:

Medium Duty %

Heavy Duty %

Trailers %

Do you have a ability to fabricate truck parts?

Yes
No

Are you a distributor of truck parts?

Yes
No

How many shop personnel are certified in truck collision repair?

Is the owner certified?

Yes
No

Is the shop manager certified?

Yes
No

Do you have all necessary local, state, and federal licenses?

Yes
No

Are you in compliance with all EPA and OSHA guidelines?

Yes
No

Please list any industry certifications you have and truck associations you are associted with.