MedGuard Protection Plans - Service Provider Application

Service Provider Application

MedGuard Protection Plans: Service Provider Application

Thank you for your interest in becoming a service provider for MedGuard Protection Plans.

Providing best-in-class customer service is our primary mission. As such, we require all service providers to be highly qualified, background checked and committed to providing outstanding customer support. Please provide the information below to get the application process started.

An application confirmation will be sent to you at the email address you provide. Please check your spam folder in the event that the confirmation email is not received.

Service Provider Information

Company Name*

Company Website

Tax ID#

Company Address 1*

Company Address 2

City*

State*

Zip*

Primary Contact Information

First Name*

Last Name*

Email*

Phone

Equipment Service Information

Please provide a list of all equipment your organization services, along with any manufacturer limitations (comma separated).*

Please provide a list of all zip codes serviced by your technicians (comma separated).*

Please provide any relevant training or certifications held by your technicians, as well as factory service authorizations held by your organization.*

Number of Technicians*

Service Call Fee(s) and Hourly Rate(s)*

Parts Mark-up (expressed as either a dollar amount or % of part price).*

Please provide your Parts and Labor Warranty.*