Choice Solutions Service, Inc.
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Personal & Contact Experience & Education Certifications & Licenses   Other Details & Agreement Docs  
     
     
  Full Name
(initials not acceptable)
First Name Middle Name Last Name
       Please enter your name exactly as shown on your income tax return form
  Goes by Nickname :
     
  User Name
Attach your Photo:
  Password  

Password should atleast be of 6 characters with one alphabet and a number
  Confirm Password
  Primary Email:
     
  Address:
  Zip:
  State:
  City:
     
  Is mailing address same as above address? Yes No
     
  Mailing Address:
  Zip:
  State:
  City:
     
  Have you ever been known by any other names? Yes No
  If yes, give the names:
     
  Social Security Number:
Attach Copy of Social Security Card:
     
  Are you doing business as DBA? Yes No
  LLC/Corp./Partnership Name:
  Federal Tax Classification:
  Tax Id:
(Employe Identification Number)
 
  Payee Print Name:
 
     
  Valid Driver’s License Number:
Attach Copy of Drivers License:
  Issuing State:
     
  Date of Birth:
  Place of Birth State:   City:
     
  Home Phone:
  Mobile Phone:   
 
  Facebook Address:
  Twitter Address:
  Google+ Address:
     
  List your residences for the last ten (10) years starting with your current address, giving:
 
Date From Date To Address State
City
Delete this row
Delete this row
Add Row  
     
  Primary language:
  Other languages:
     
  Do you have a valid passport? Yes No
Attach Copy of Passport:
  If yes, give expiration date:
     
  Shirt Size:
     
  Upload Resume.
     
Service Provider User type change



 

Registration Instructions

1. Once you begin with your registration, you may first fill in personal details such as your Full Name, User Name, Password, Social Security Number, Physical Address and Email Address and then click on the "Save" button.

2. After you 'Save' you will be required to validate your email address. This will enable us to send you notifications as far as deployment or revenue generating opportunities for you. You will receive a Welcome e-mail as soon as your registration form is saved and validated. This welcome email will include your User Name and Password.

3. You may then continue filling other details on the registration form. If you wish you may come back to it later by logging into your account.

4. You need to review and electronically sign documents such as the Agreement/Contract, W9 and Direct Deposit form (optional) from the “Others & Agreement” tab. However you need to save your registration and then login back to e-sign the documents.

 
Profile Progress Information
Including the following information will improve your Profile Completion Progress. To refresh this list click on the "Save" button.
First Name
Last Name
Service Provider Photo
User Name
Password
Email
Street Address
Zip
State
City
SSN
Social Security Card Copy
Drivers License Copy
Drivers License Number
Drivers License State
Date of Birth
Place of Birth
Home Phone
Mobile Phone
Facebook
Twitter
Google+
List of residences for the last ten(10) years
Primary Language
Other Languages
Shirt Size
Professional References
Education
Software Experience
Experience on Claim Types
Capability to Climb
Capability To Climb Steep
Auto Carrier
Auto Limit
Auto Policy Number
Auto Expiry
Professional, occupational and vocational Licenses
List of Professional Designations
Claim Type Preferences
Other Claim Type Preferences
Consider working a desk as an Inside Examiner
Experience working as an Inside Examiner
Experience working as an Inside Examiner Date
Company (Inside Examiner)
Copy of Agreement Document
Copy of W9 Document
Copy of Direct Deposit Form
 
License Details

(If your home state does not require a license please enter your primary state license number. If you have adjusting experience in a state that does not require a license and you have not obtained a license from another state please enter “none”)
Home State License #

State issued

Xactnet Address

©2021 Choice Solutions Services, Inc. All Rights Reserved. Server: App01.
Registration Instructions

Are you a licensed insurance adjuster or do you have adjusting experience and live in a state that does not require a license?

License Details

License #

State issued

Additional Licenses

Xactnet Address