Company Information Form


CDC  (Call Directing Code):

1. Legal name of your company:

2a. Your company's IOWA representative Contact & mailing address for on going correspondence or questions.

NAME:
TITLE:
MAILING ADDRESS:
CITY:  
STATE:
ZIPCODE:
PHONE NUMBER:   
FAX:
E-MAIL ADDRESS:

 

2b. Your company's billing address.

NAME:
TITLE:
MAILING ADDRESS:
CITY:  
STATE:
ZIPCODE:
PHONE NUMBER:   
FAX:
E-MAIL ADDRESS:

 

3. Receiving company contact information/site receiver information.

CONTACT NAME:
PHONE NUMBER:
FAX NUMBER:
E-MAIL:
MAILING ADDRESS:
PRIMARY

RECEIVING DEVICE:
RECEIVING

PHONE NUMBER :

4. Normal Workday Message Receiver Site:

NORMAL WORKING HOURS :      

WORK WEEK: Monday Tuesday Wednesday Thursday Friday Saturday Sunday 

TYPE OF EQUIPMENT: check one



FAX:  YES

PRINTER:  YES

COMPUTER:  YES

 

E-MAIL: (LIMIT =70 CHARACTERS)

 

EQUIPMENT  PHONE NUMBER:

CONTACT NAME:

PHONE:

 

EQUIPMENT ADDRESS:

*Type of Receiving Software

 

5.  Voice Notification

This is in addition to the normal message transmission to your receiver site.

A. During Normal business hours, my company would like a BACKUP VOICE Message for:

*There is a $1.00 per notification during working hours for Emergency or Dig-in Voice Notifications.

Accept: Deny: 
               

EMERGENCY: Yes No 

PHONE:

    Emergency = When  caller states the work to be preformed is of an emergency nature.  

    * One Call Concepts considers this as an additional message with appropriate billing (currently at $1.00)

DIG-IN:   Yes No  

PHONE:

    Dig-in = when caller states that a line has been exposed, damaged, or a gas leak etc.

    *This service is including in Normal operating costs.

     

                        
WORK HOURS REFFERRAL  NUMBER:

B. After Normal Business Hours, my company would like a BACKUP VOICE Message for:
1. EMERGENCY: yes no   

Emergency = When  caller states the work to be preformed is of an emergency nature.   *This service is included in Normal operating costs. 

                 
2.  DIG-IN:  yes no   

PHONE:

Dig-in = when caller states that a line has been exposed, damaged, or a gas leak etc.

*This service is including in Normal operating costs.

 

AFTERHOURS REFERRAL NUMBER IF EMERGENCY OR DIG-IN
Referral number – If requested by caller

 

6. Emergency Referral number: (If different from 5a and 5b)

Referral number – If requested by caller

 

    
7. Holidays observed by your company: LIMIT 15
                 
This information is needed by the call center to know when your receiving location is operational. Holidays observed by the Iowa Law are: New Years Day, Martin Luther King Day, Presidents Day, Memorial day, Independence Day, Veterans Day, Thanksgiving Day, Christmas Day. These holidays and weekend are excluded from the 48 hour required notice. All other holidays your company observes do not fall under this exclusion.

          


Holidays

Full Day

Half Day
Hours of Operation

Date

Holidays

Full day

Half Day
Hours of Operation

Date

New Years Day

 YES

 

 

Columbus Day

 YES

  

 

Martin Luther King Day

 YES

  

 

Election Day

 YES

  

 

Lincoln's Birthday

 YES

  

 

Veterans Day

 YES

  

 

Presidents Day

 YES

  

 

Thanksgiving Day

 YES

  

 

Washington's Day

 YES

  

 

Thanksksgiving Friday

 YES

  

 

Good Friday

 YES

  

 

Christmas Eve

 YES

  

 

Memorial Day

 YES

  

 

Christmas Day

 YES

  

 

Independence Day

 YES

  

 

New Year's Eve

 YES

  

 

Labor Day

 YES

  

 

Other

 YES

  

 

If the holiday list changes or an office closes early the day before a holiday, please inform the call center of this information.

 

8. Please indicate the type of Underground Facilities you are protecting
Other: