Create Partner Account - QTS Partner Portal

Please fill out the information below and a partner account will be created for you. You may be required to provide a credit card as a default payment payment source for performed trips. After your account is created, you will receive an email with your credentials, which will allow you to login and view your rate sheet.

Facility Information

Facility Name:

Facility Address:

Facility Address2:

Facility City:

Facility State:

Facility Zip:

Facility Phone:

Facility Type:

Who will pay for transportation:

Billing Contact Information

Billing First Name:

Billing Last Name:

Billing Address:

Billing Address2:

Billing City:

Billing State:

Billing Zip:

Billing Phone:

Billing Email Address:

Billing Fax Number:

Trip Information

Weekly Ambulatory Trips:

Weekly Wheelchair Trips:

Weekly Stretcher Trips:

Comments/Questions:

Company Information

Facility Information

Billing Contact Information

Trip Information