Concierge On Call
 
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  Please provide information about your company. Only complete the fields that apply. 
   
Please provide contact information
 
 
Name
   
Title
  
Organization
 
Newsletter  
 
Work Phone
 
Home Phone
 
FAX
 
E-mail
 
Web Address
 
 
Addresses to keep on file
 
Address type
 
Street Address
 
Address (cont.)
 
City
 
State/Province
 
Zip/Postal Code
 
Country
 
 
 
List the key contact people
  
     

.

 
   
How many staff do you employ? 
   
 
List the licenses you hold in the space provided below.
  

   
Enter your worker's compensation number in the space provided below.
  

   
     
Enter your GST number in the space provided below.
  
   
   
How long have you been in business?    yrs
  
   
Please provide the following insurance information:
Contact Name
Policy Number
Company
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Phone
FAX
E-mail
 
Please provide three references:
Reference 1
Reference 2
 
            Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
FAX
E-mail
Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
FAX
E-mail
 		    
Reference 3
Reference 4
 
Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
FAX
E-mail
Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
FAX
E-mail

 
 
 
     
     

Enter the geographical areas that you work in the space provided below. ie SW, NW, Okotoks etc

 
 
Describe or list all the services you offer.

 
What is your customer service policy/guarantee?

 

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2412, 246 Stewart Green SW
Calgary, Alberta, Canada, T3H 3C8
Ph: (403) 228-7703 Fx: (403) 228-7996
 concierge@conciergeoncall.com
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