Service Provider Application - Specialty Networks

Building and Strengthening Lasting Relationships

Thank you for your interest in joining the Cross Country Network for Accident Scene Management and Vehicle Release Management Services! Please complete the attached application and we will contact you shortly thereafter. We look forward to making you part of our growing team!

Sincerely,

Network Services

Profile Information

General information about your current status with Cross Country and future desires to join our existing networks.
Company Name
Contact Information and Title
Service Provider ID
Are you currently contracted with Cross Country?
Yes No
Do you have a secured storage facility?
Yes No
Vehicle Release Management (VRM)

Secondary towing and VRM allows you to maximize your fleets productivity and earn new revenue streams with new kinds of customers. These types of calls require your company to pick up cars that have been involved in an accident from either a body shop or a customers house. Your responsibility will be to deliver these vehicles to the body shop designated with the following time frames: IF dispatched before 12 PM, vehicle to be delivered by 5 PM local time; IF dispatched after 12 PM local time, 24 hours to complete the call.
Do you currently take secondary calls?
Yes No
If yes, please indicate with whom
How do you currently get reimbursed for secondary calls?
Check Credit Card Company Check Direct Deposit Other
How frequently are you being reimbursed?
24 hours 48 hours 7 days 14 days
What is the maximum dollar amount you can advance on a daily basis?
$0 $1 - $100 $101 - $500 $500 +
Does your current territory accurately reflect the area you wish to service?
Yes No
If no, please indicate which zip codes you wish to service
Accident Scene Management (ASM)

After an insured customer notifies their insurance company that they have been involved in a motor vehicle accident, a Priority ASM Service Provider responds directly to the scene of an accident within 20 minutes and moves the vehicle to the designated repair facility
Do you currently handle accident calls?
Yes No
If yes, please check all those you service accident calls for
Body Shops Police / Municipality / Sheriff Department Dealerships Insurance Companies Motor Clubs
Can you arrive to scene within 20 minutes of dispatch?
Yes No
Desired Service Territory:
Please indicate by zip code those in which you can respond to within 20 minutes
Do Not Fill This Out

Wufoo

Service Provider Application - Specialty Networks

Profile Information

Vehicle Release Management (VRM)

Accident Scene Management (ASM)