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Online Quote

 

New Account Information:

Today’s Date: *
Name of Business *
Billing Address
Telephone *
-
Fax
-
Primary Contact *
E-mail *
Start Date
End Date
Type of Business
AP contact
AP phone
-
AP fax
-
Job site contact
Job site phone
-
Type of Service
Type of Service
Select if Mobile
Guard Shack/Station on site? *
Guard access to a restroom? *
Guard access to a telephone?
(for emergency’s only)
*
Sales Tax Exempt?
(if yes, copy must be sent to us)
Mine Permit #
(coal mines only)
Name of Mine Site
(coal mines only)

Work Schedule:

24/7 coverage?
(if no, complete daily schedule below)
*
Mon: Time On
 : 
Tue: Time On
 : 
Wed: Time On
 : 
Thu: Time On
 : 
Fri: Time On
 : 
Sat: Time On
 : 
Sun: Time On
 : 








Mon: Time Off
 : 
Tue: Time Off
 : 
Wed: Time Off
 : 
Thu: Time Off
 : 
Fri: Time Off
 : 
Sat: Time Off
 : 
Sun: Time Off
 : 

Total Weekly Hours?
(if not 24/7 coverage)
Guard Duties
How did you hear about us?
Name of person completing form *
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