Service Partner Application

About Your Business

First Name:

Last Name:

Business Name:

Address: City: State: ZIP:

Phone:

Fax:

Checks Payable To:

Checks Mailed To: City: State: ZIP:

Type of Business: Name of VIR Affiliate Associated With:

Repair Experience

Years Experience:

Professional Training or Trade School:

References:

Tell Us About Your Shop and/or Capabilities:

Strengths & Specialties:

Tasks or Instruments You Can't Handle:

Create Your Login

Email:

Password: Confirm Password:

Check the box before submitting form.

Terms & Conditions

By submitting your online application, you agree to the following Terms & Conditions of the VIR Service Partner Agreement: A. The VIR Service Partner Agreement may be terminated at any time by either Party for any reason. At that time, any outstanding reimbursement requests will be reviewed & satisfied within 30 days of termination. B. As a Service Partner, you agree to submit reimbursement requests that are timely, accurate, complete, and valid, while using the current version of VIR's Reimbursement Schedule (PDF download at Portal). C. VIR reserves the right to adjust any fees exceeding the Reimbursement Schedule allowance (unless otherwise agreed upon by VIR & Service Partner). VIR also reserves the right to refuse/void any reimbursement request and/or immediately terminate the VIR Service Partner Agreement if fraudulent reporting is discovered (additional legal consequences may apply and vary by State).