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 ?

Car and Van
Heavy commercial and specialist bodies

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):

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

27. Opening times:

Monday to Friday:
Saturday:
Sunday:

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?

Yes
No
In progress

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. Name:

37. 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