New Repairer Registration Form

 
Please complete and submit this form to apply to join the Selsia Approved Repairer Network

1. Which approved network are you applying for ?

 

2. Company name:

 

3. Main contact person:

 

4. Address:

 

5. Main telephone number:

 

6. Email for new repair instructions:

 

7. Accounts email address for remittances:

 

8. CAPS code:

 

9. VAT number:

 

10. Registered address (if different):

 

11. Company registration number:

 

12. Main contact position:

 

13. Main contact mobile number:

 

14. Email:

 

15. Operational contact person:

 

16. Operational contact mobile number:

 

17. Operational contact Email:

 

18. Company web site address:

 

19. Manufacturer approvals:

 

20. Insurance approvals:

 

21. Other approvals held:

 

22. Bodyshop management system used:

 

23. PAS125 / BS10125?

 

24. If yes, what is your certificate number?

 

25. If PAS approved, what is the expiry date of the certificate?

   DD/MM/YYYY 
 
 

26. List up to 10 additional services which you offer (for your dedicated page on the Selsia web site):

 

27. Opening times:

 
If you have any photos of your logo and premises, please email separately to:

neil.marcus@selsia-vac.co.uk

28. Post codes covered:

 

29. Do you have suitable anti-slavery and human trafficking policies and processes?

 

30. Accounts contact name:

 

31. Accounts email address for invoices:

 

32. Name of bank:

 

33. Bank account name:

 

34. Bank account number:

 

35. Sort code:

 

36. Do you factor your invoices?

 

37. Name of factoring agent

 

38. Name:

 

39. Date:

   DD/MM/YYYY 
 
 
Selsia Vehicle Accident Centres Limited, Endeavour House, Wrest Park, Silsoe, Bedfordshire, MK45 4HS

 
Telephone:  0333 444 5500
Email:          info@selsia-vac.co.uk
Web site:     selsia-vac.co.uk