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Services
Fleet Safety
Liability Protection
Collision Management
Loss Recovery
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Driver Training, Recognition & Communications
CEI Insurance Services
Resources
Case Studies
White Papers
Products
Communications
Video Library
Customer Login
DriverCare 5.0
ClaimsLink
Contact
Shop Network Inquiries
Claim Assistance
CEI Network
/ The CEI Direct Repair Network™ Application
The CEI Direct Repair Network™ Application
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
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
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
Under $300,000
$300,000-$600,000
$600,000-$999,000
$1M - $2M
Over $2M
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.
Name:
Date: