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Company/Chain Name
*
First Name
*
Last Name
*
Email
*
Your Title
*
Your City
*
Your State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Your Zip Code
*
Your Phone Number
*
Target Bill Rate & Duration
Target Bill Rate
*
Duration of Security
*
Choice 8
Emergency Guard Service
Temporary Guard Service
Permanent Guard Service
Other
If you selected other please explain here
Reason for Security
Details why Security is needed - Please be specific
Location Where Security is Needed
Site Name
*
Site Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Service Details (Shift 1)
If you only have one shift type, please just use this section and leave the others blank. If you have multiple shift types, such as Monday - Friday is one type, and Saturday - Sunday is another type, you can fill out the multiple shift boxes.
# of Guards
*
# of Days
*
Service Type
*
Choice 1
Armed
Unarmed
Armed and Unarmed
Unarmed (Suit & Tie)
Armed (Suit & Tie)
Unarmed Patrol Vehicle
Armed Patrol Vehicle
Fire Watch
Loss Prevention
Unarmed Bodyguard
Armed Bodyguard
Special Event
Other
Start Date/Time
*
Date
Time
End Date/Time
*
Date
Time
Service Details (Shift 2)
Use this section if you have multiple shift types to define. For example, your Monday-Friday shift is 8 hours but you want 24-hour coverage on weekends.
# of Guards (2)
# of Days (2)
Service Type (2)
Choice 1
Armed
Unarmed
Armed and Unarmed
Unarmed (Suit & Tie)
Armed (Suit & Tie)
Unarmed Patrol Vehicle
Armed Patrol Vehicle
Fire Watch
Loss Prevention
Unarmed Bodyguard
Armed Bodyguard
Special Event
Other
Start Date/Time (2)
Date
Time
End Date/Time (2)
Date
Time
Service Details (Shift 3)
Use this section if you have multiple shift types to define.
# of Guards (3)
# of Days (3)
Service Type (3)
Choice 1
Armed
Unarmed
Armed and Unarmed
Unarmed (Suit & Tie)
Armed (Suit & Tie)
Unarmed Patrol Vehicle
Armed Patrol Vehicle
Fire Watch
Loss Prevention
Unarmed Bodyguard
Armed Bodyguard
Special Event
Other
Start Date/Time (3)
Date
Time
End Date/Time (3)
Date
Time
Service Details (Shift 4)
Use this section if you have multiple shift types to define.
# of Guards (4)
# of Days (4)
Service Type (4)
Choice 1
Armed
Unarmed
Armed and Unarmed
Unarmed (Suit & Tie)
Armed (Suit & Tie)
Unarmed Patrol Vehicle
Armed Patrol Vehicle
Fire Watch
Loss Prevention
Unarmed Bodyguard
Armed Bodyguard
Special Event
Other
Start Date/Time (4)
Date
Time
End Date/Time (4)
Date
Time
Name
Submit
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