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(855) 925-2469

Enroll with Riveredge. It’s Easy.

We’ll need some basic information to get started.

Company Information

Review

Authorize

The information you provide will remain safe and confidential

Company Information

Please complete a separate application for each corporate or business entity. 
This is the registered or incorporated name under which your business conducts its operations. 
This is the trade name, or fictitious business name, under which your business is conducted. 
We will need this information in order to establish your business eligibility. 
We will need this information in order to establish your business eligibility. 

Yes

No

Does Your Business Accept Credit Cards?

We will need this information in order to determine your total claim. 

Yes

No

Does Your Business Have Multiple Locations?

Business Address


Authorized Representative Contact Information

An Authorized Representative is a member of the company authorized to enter into contracts on behalf of the company. 

Required Field

Questions? We’re here to help.

Chat with a Riveredge Representative Now:

(855) 925-2469