Provider Application
Nine short sections. Have your insurance certificate, W-9 and equipment list ready to upload. You can save and return before submitting.
15 minWith documents on hand
3 daysTypical review time
$0No fee to join
Call(855) 706-7800 and ask for onboarding
01ContactRequired
02FacilityRequired
03Services And EquipmentRequired
04Coverage RadiusRequired
05HoursRequired
06Insurance And BackgroundRequired · Uploads
07Years In BusinessRequired
08How You Heard About UsOptional
09TermsRequired
Submitting opens an email to our onboarding team with your answers. Attach your certificate of insurance, W-9 and registrations to that email. We reply within three business days.
Before You Start
- Certificate of insurance, current
- W-9 in the paid entity's name
- Registration for each unit
- Equipment list by unit
- USDOT number, if applicable
Questions while applying? Call (855) 706-7800 and ask for onboarding.Live 24 hours a day.