Technician

Become a Technician

Please fill out the form below if you’re interested in partnering with us as a technician.
Copy of Insurance is to be submitted.
If you have questions, please call us at 888-848-2630.
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Contact/ Company Name *

Company Tel *

Address *

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City

State

Zip Code

Country

Company Email *

Years in Business *

Are you an accredited business with BBB *

EIN#* *

State Resale Certificate# *

Work Area Radius (miles) *

Are you Insured? *

Please attach a copy of insurance. *

Max file size: 20MB

Do you have any criminal record? *

Please note if you agree to render warranty services for titan chair, all work orders must be completed within 4 business days of receiving the work order

Additional Information about your company *

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