New Client Form New Client Form New Client Current Client UpdateCompany Name*DBA (if different)Primary Contact Person*Cell Phone NumberAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code A/P Contact PersonPhone Number*Accounts Payable Email* (Statements and invoices will be emailed to this address)Shipping Address (If Different) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is a Purchase Order (PO Number) required for invoicing?YesNoContact information for Individual(s) to Receive Results (in addition to Primary Contact)NameEmail Please give us a quick description of your reason for callingOur labor rates are as follows: Normal Business Hours Labor Rate: $116.79/hr. location to location Service Call Charge - $70.00 Emergency After Hour Rates - $175.19/hr. location to location Our business hours are as follows: Normal Business Hours: Monday – Friday 8:00 a.m. – 5:00 p.m. Emergency After Hours: Monday – Friday 5:00 p.m. – 8:00 a.m. Saturday and SundayDo you understand our billing practices and rates as described above?* Yes, I understand the billing rates No, I do not understand the billing rates(In an effort to reduce paper waste, all reporting and invoicing will be electronic unless otherwise indicated)PhoneThis field is for validation purposes and should be left unchanged.
