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JESA Nationwide Services, Inc. Network Installation / Service Qualification Questionnaire

Company Name:
Owner/Manager:
Mailing Address:
City:
State:
Zip Code:

Service Contact:
E-Mail:
Installation Contact:
E-Mail:

Hours of Operation:
Contact Info
Main Phone:
Fax:
Emergency Phone:
E-Mail:
Web Site Address:

How Many Technicians on Staff?
Service Technicians?
Bench Technicians?

How is Emergency Service Handled (e.g. After Hours/Weekend/Holiday)?

Do you Have a Guaranteed Response Time?	Yes No
If yes, What are the Parameters?


Does your Company have a Low-Voltage License?	Yes No
If yes, Licensed in Which States, Municipalities, Counties?

Please List all Low-Voltage Contractor License Numbers Here


Is your Company Union Affiliated?	Yes No
If yes, Please list Union and Local?

If no, is Company Located in Right to Work State?	Yes No

Does your Company have a Journeyman Low-Voltage Tech on Staff?	Yes No
If yes, provide Technicians Certification Number:


Does your Company have access to a Union Subcontractor?	Yes No

Can your Company Install 110v Power?	Yes No
If yes, Does your Company Hold an Electrical License?	Yes No
If yes, provide Electrical License Number:


Can your Company Install Conduit?	Yes No
If yes, What are the Limitations?


Please List States and/or Counties Covered under your Install/Service Teritory?
Install:
Service:

Please List any Branch Offices with Contact Information:


Please List Hourly Labor Rate?
Non-Union Installs
Union Installs
Service
Emergency Service

Travel Rates:
For Service Outside of 1 Hour or 50 Mile Radius:
For Installs Outside of 1 Hour or 50 Mile Radius
Please Note that JESA does NOT pay trip charges, mileage, or service fees

If you Like a Hardcopy of This Completed Form be Sure to Print this Page Prior to Submission.