SUBMIT COMPANY INFORMATION

| Login

COMPANY INFORMATION SUBMISSION FORM
Use this form to register as a new member or to update your existing contact personnel and communication preferences.

YOUR INFORMATION
NAME:
TITLE:
PHONE:	(please include area code)
FAX:	(please include area code)
EMAIL:
CALL DIRECTING CODE(S):	(if applicable)
COMPANY'S INFORMATION
COMPANY'S LEGAL NAME:
STATE OF INCORPORATION:
SD NAME (IF DIFFERENT):
BUSINESS ADDRESS OF HEADQUARTERS:
CITY:	ZIPCODE:
COMPANY'S BILLING INFORMATION
NAME OF PERSON TO BILL:
TITLE:
PHONE:	(please include area code)
FAX:	(please include area code)
EMAIL:
ADDRESS:	ZIPCODE:
CITY:	ZIPCODE:
COMPANY'S ONE CALL CORRESPONDENCE REPRESENTATIVE
NAME:
TITLE:
PHONE:	(please include area code)
FAX:	(please include area code)
EMAIL:
ADDRESS:	ZIPCODE:
CITY:	ZIPCODE:
ALTERNATE CORRESPONDENCE REPRESENTATIVE (optional)
NAME:
TITLE:
PHONE:	(please include area code)
FAX:	(please include area code)
EMAIL:
ADDRESS:	ZIPCODE:
CITY:	ZIPCODE:
MESSAGE RECEIVER SITE/LOCATION INFORMATION
Note: If your company will be receiving tickets at more than one location, then this form must be submitted for each receiver location.
CONTACT:
PHONE:	(please include area code)
FAX:	(please include area code)
EMAIL:
ADDRESS:
CITY:	ZIPCODE:
PRIMARY RECEIVING DEVICE:	EMAILPCPRINTERFAXOTHER
RECEIVING EMAIL OR PHONE:

WORKING HOURS & HOLIDAYS
NORMAL WORKING HOURS:	to
WORK WEEK:	MONTUEWEDTHUFRISATSUN
The following holiday information is needed by the Call Center in order to know when your receiving location is operational. If this list changes or an office closes early the day before the holiday, please make such an indication below or notify the Customer Service department at 1-800-873-3588 when they are leaving. If the office will be closed for more than one consecutive day, please list a range in the date(s) field.
HOLIDAY	FULL DAY	HALF DAY	DATE(S)
NEW YEARS DAY
MARTIN LUTHER KING DAY
LINCOLNS BIRTHDAY
PRESIDENTS DAY
WASHINGTONS BIRTHDAY
GOOD FRIDAY
MEMORIAL DAY
INDEPENDENCE DAY
LABOR DAY
COLUMBUS DAY
ELECTION DAY
VETERANS DAY
THANKSGIVING DAY
THANKSGIVING FRIDAY
CHRISTMAS EVE
CHRISTMAS DAY
NEW YEARS EVE
OTHER:

TELEPHONE NOTIFICATION INFORMATION - DURING WORK HOURS
Do you wish to receive a voice message from the Call Center (in addition to the regular message transmission) for the following?
EMERGENCY	YESNO	IF YES, PHONE: (please include area code)
DAMAGE	YESNO	IF YES, PHONE: (please include area code)
TELEPHONE NOTIFICATION INFORMATION - AFTER WORK HOURS
Do you wish to receive a voice message from the Call Center (in addition to the regular message transmission) for the following?
EMERGENCY	YESNO	IF YES, PHONE: (please include area code)
DAMAGE	YESNO	IF YES, PHONE: (please include area code)

TYPE OF UNDERGROUND FACILITIES THAT YOU ARE PROTECTING
CABLE TVGASELECTRICWATERSEWERPIPELINETRAFFIC LIGHTTELECOMMUNICATIONS
OTHER
SALES TAX STATUS
DIRECT PAYEXEMPTPAY TAX
IF DIRECT PAY, PLEASE ATTACH A COPY OF DIRECT PAY PERMIT. IF EXEMPT, PLEASE ATTACH A COPY OF EXEMPTION CERTIFICATE.

ADDITIONAL INSTRUCTIONS