Step 1 of 333%Company InfoCompany NamePhysical Address Street Address City State / Province / Region ZIP / Postal Code Mailing Address Same as Physical Street Address City State / Province / Region ZIP / Postal Code PhoneFaxCompany Email Please select business type: LLC Corporation How long have you been in business?Less than a year1 Year2 Years3-5 Years5-10 Years10+ YearsPoints of ContactOwner First Name Last Name PhoneEmail Service Manager First Name Last Name PhoneEmail Billing Contact First Name Last Name PhoneEmail Service InformationPlease select the items you service: Range Refrigerator Dishwasher Clothes Washer Clothes Dryer Trash Compactor Microwave Water Heater Plumbing Electrical Air Conditioner Furnace Heat Pump Boiler Swamp Cooler Septic Systems Well Pump Pool/Spa Equipment Please list any brands your company does NOT servicePrimary Service TerritoryService Territory RadiusHow long do you guarantee your:Labor?30 Days60 Days90 Days1 YearLonger than 1 yearParts?Parts?30 Days60 Days90 Days1 YearLonger than 1 yearHours of OperationDo NOT include overtime hours. Enter your start time in the first dropdown and your end time in the second.Monday - Friday Open12:00AM1:00AM2:00AM3:00AM4:00AM5:00AM6:00AM7:00AM8:00AM9:00AM10:00AM11:00AM12:00PM1:00PM2:00PM3:00PM4:00PM5:00PM6:00PM7:00PM8:00PM9:00PM10:00PM11:00PMMonday - Friday Close12:00AM1:00AM2:00AM3:00AM4:00AM5:00AM6:00AM7:00AM8:00AM9:00AM10:00AM11:00AM12:00PM1:00PM2:00PM3:00PM4:00PM5:00PM6:00PM7:00PM8:00PM9:00PM10:00PM11:00PMSaturday Open12:00AM1:00AM2:00AM3:00AM4:00AM5:00AM6:00AM7:00AM8:00AM9:00AM10:00AM11:00AM12:00PM1:00PM2:00PM3:00PM4:00PM5:00PM6:00PM7:00PM8:00PM9:00PM10:00PM11:00PMSaturday Close12:00AM1:00AM2:00AM3:00AM4:00AM5:00AM6:00AM7:00AM8:00AM9:00AM10:00AM11:00AM12:00PM1:00PM2:00PM3:00PM4:00PM5:00PM6:00PM7:00PM8:00PM9:00PM10:00PM11:00PMSunday Open12:00AM1:00AM2:00AM3:00AM4:00AM5:00AM6:00AM7:00AM8:00AM9:00AM10:00AM11:00AM12:00PM1:00PM2:00PM3:00PM4:00PM5:00PM6:00PM7:00PM8:00PM9:00PM10:00PM11:00PMSunday Close12:00AM1:00AM2:00AM3:00AM4:00AM5:00AM6:00AM7:00AM8:00AM9:00AM10:00AM11:00AM12:00PM1:00PM2:00PM3:00PM4:00PM5:00PM6:00PM7:00PM8:00PM9:00PM10:00PM11:00PMInvoice InformationPlease select your primary billing method: Time and Materials Flat Rate What is your trip charge or diagnostic fee?What is your labor rate per hour?What is your markup on parts?Name of person completing this form: First Last Email Address Zip CodesPlease upload a document containing a list of zip codes for your service area.Accepted file types: txt, zip, doc, docx, pdf, rtf, Max. file size: 20 MB.Δ
