*
- Required Fields
User Name :
*
Password :
*
Confirm Password :
*
Company Name :
*
Number of Locations :
1
2
3
4
5
6
7
8
*
Owner Name :
*
Principle Contact Name :
*
Business
Telephone Number
:
*
Dedicated
Fax Number
:
*
Company
Email Address
:
*
Web Address :
Number of Service Technicians you have?
Inside
:
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Outside
:
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Number of Service Vehicles :
Uniformed Filed Technicians?
:
Yes
No
Service Vehicles Identified with Company Info?
:
Yes
No
How would you prefer to be notified of a Service Request?
Phone
Fax
Email
Service Contact name
Emergency Service Nunumber
What is your standard mileage radius for on-site service
calls?
10
15
25
50
100
Miles
What is your rate per mile beyond your standard
travel radius? $
Type of Services??
Onsite
Carry-In
Dept.
Plasma
DLP
LCD
Projector
Home Theater
What days of the week are you available for On-site Service Calls?
Please check the appropriate days.
Mon
Tue
Wed
Thu
Fri
Sat
Sun
What are your normal hours of operation?
1
2
3
4
5
6
7
8
9
10
11
12
AM
PM
To
1
2
3
4
5
6
7
8
9
10
11
12
AM
PM
Do you Sub-Contract any of your service?
Yes
No
Method of Dispatching You Use For Your Techs :
Computerized
Visual
2-way radio
Phone
Pager
Email
What is your average turn-a-Round time?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Days
What is the length of your Repair Warranty?
Parts
:
30
60
90
180
365
Days
Labour
:
30
60
90
180
365
Days
Are you a member of a Trade Association?
NESDA
PSA
Other
Photo (Optional) :
