VersiTrax Registration of Insured

Welcome to VersiTrax’s Registration of Insured Page! If you are on this page, then you were provided a link and Client Code to complete your registration as a vendor, subcontractor or supplier. Please provide necessary information below and click “Submit”. Within 15 minutes, you will be able to start e-mailing or faxing your Certificates of Insurance to the VersiTrax system.

Client Code:

Certificate Contact First Name:

Certificate Contact Last Name:

Title:

Company Name:

Address:

City:

State:

Zip Code:

Phone Number:

Fax Number:

Certificate Contact’s E-mail:

Federal Tax ID:

Vendor Number (If Known):

Notes:

First Name *

Last Name *

Company *

E-mail address *

Phone *

Address

City

State

Zipcode

Interested In?

Referrer/How Did you Hear About Us ?

Comments

1-866-835-2979

Speak with a live sales agent.
Chat Now
Hours: Monday – Friday
6:00 am – 5:00 pm
Pacific Time