Contractor On-line Applicaiton

Network Consulting Services Contractor Application

For consideration as a network consulting services contractor for Datatrend Technologies Network Services, please complete the application below:

Company Information

Mailing Address Company Name:*
Address:*

City:*
State:* Zip:*
Phone:*
Fax:
Web site:

Shipping Address:(if different) Address:

City:
State: Zip:

Billing Address:(if different) Address:

City:
State: Zip:

Contact Information

Primary Contact Primary Contact:*
Title:
Email:* name@website.com
Phone:*
Fax:
Cell:

Secondary Contact Secondary Contact:
Title:
Email: name@website.com
Phone:
Fax:
Cell:

A/R Contact A/R Contact:
Title:
Email:
Phone:
Fax:
Cell:

General Information Date Business Started:*

Type of Business:*
C Corporation S Corporation Partnership Proprietorship LLC

Federal Tax Identification Number:*

Contractor License No.:

Is firm listed above an affiliate or subsidiary of another firm?* Yes No
If Yes, name of Parent Company:
Address:
Do you have other offices?

Disadvantaged Business?* Yes No
Disadvantaged Business Type
DBE/Disabled Business Enterprise
DVBE/Disabled Veteran Business Enterprise
MBE/Minority Business Enterprise
WEB/Women Business Enterprise

Languages Supported (i.e. English, Spanish, French, etc.)

Are You Union Members?* Yes No
Union:
Industries Served:* Commercial Residential Government

Types of Services you provide:*
Data Cabling Voice Cabling Fiber Install Security Electrical
Others

If no Electrical Services, do you subcontract electrical work with local electricians? Yes No

Have your technicians installed:
Routers Switches Servers PBX POS

Can you provide technicians on site with laptops? Yes No

Can your technicians complete RF Wireless coverage surveys? Yes No

Number of technicians on staff:*

Number of BICSI RCDD's on staff:

What type of Testing Equipment do you use for data cabling and fiber:

Typical Hourly rate for a Time & Material Service Call
Data/Voice/Fiber* $
Electrical* $
Other $

Coverage Area:*

How far will your crews travel without travel charges?
How far will your crews travel with price negotiation?

References List your recent projects or continuous service work that you have recently completed:

Reference 1 1. Customer:
Project/Service work description:

Contact Name:
Email:
Phone:
May Datatrend contact this Reference?: Yes No

Reference 2 2. Customer:
Project/Service work description:

Contact Name:
Email:
Phone:
May Datatrend contact this Reference?: Yes No

Insurance Coverage Commercial General Liability Coverage:* Yes No
Current Limits per occurrence:
Aggregate:* $

Workers Compensation Coverage:* Yes No
Current Limits per Accident:* $
Disease Policy limit:* $
Disease each employee:* $

Contact Us Now

To consult with a Datatrend representative regarding your needs, call us now at 800.367.7472.

To request more information or a quote, please visit our Contact Us page.

Network Services

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