Agency Signup

Account Credentials

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Basic details

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Credit Card Details

Enter card details

Your credit card will not be charged. Statim is free to join and view available service providers for your emergency requests. You will be able to review and agree to service providers coverage rates prior to submitting your request through our web app. Once you agree to coverage rates you will then authorize a charge to your credit card for Statim’s connection fee.

Please confirm the details below prior to submitting

Agency Name
Branch
Email
Scheduler Name
Scheduler Phone
Credit Card xxxx xxxx xxxx 3656
Agency Street Address
Apt/Suite/Room#
City
State
ZIP Code
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