BECOME A PARTNER FILL OUT FORM BELOW TO Become a Service Partner Contact Us SERVICE PARTNER INFORMATION Please Input Your Company's Information Below: Company Name(Required) Company Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Name(Required) First Last Contact Job Title(Required) Contact Phone(Required)E-Mail Address/Billing(Required) SERVICE CAPABILITIESPlease select each service you coverGas / Propane Yes No HVAC Yes No Plumbing Yes No Hotside Yes No Installation Yes No Electrical Yes No Refrigeration Yes No Hood / Exhaust Systems Yes No Welding Yes No Handyman Services Yes No Fire Suppression Certification Yes No Hood Cleaning Yes No SERVICE INFORMATION# of Service Technicians(Required)Please enter a number greater than or equal to 1.Service Dispatch Email Address(Required) Service Coverage Area By City Add RemovePlease add each city your company coversRegular Hourly RatesOvertime RateTravel RatesPreferred Payment Method(Required) ACH (Direct Bank Payment) Credit Card Check Are You 24/7/365(Required) Yes No Operating Hours(Required)Day of Week (Monday)Open Time (AM/PM)Close Time (AM/PM) Add RemovePlease create a new row for every day your business is open Trade Certification Yes No N/A Trade License Number(Required)Provide Industry License Number(s)/Certification(s) EPA Certification Yes No N/A EPA Classifications(Required) Type I Type II Type III Universal EPA License Number(Required)Provide License Number(s) Upload W-9Signed and dated within the past yearMax. file size: 100 MB.Please Provide Your Insurance Agent / Policy Holder with the Following Certificate Holder Information below:United Service Network 17038 Redland Rd Suite 102, San Antonio Texas, 78247Upload Certificate of InsuranceMax. file size: 100 MB.Terms and Conditions(Required) Terms and ConditionsVendor agrees to not engage in any direct or indirect business with affiliates outside of United Service Network, nor will they discuss any sort of pricing with our partners including but not limited to owners, partners, staff and or manager on duty. By clicking submit, you give United Service Network express written consent to send text messages regarding our product and services. Standard data and message rates may apply.PhoneThis field is for validation purposes and should be left unchanged. SERVICE CAPABILITIES