Request Quote – United Traffic Control Services

1Project Information

2Billing Information

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Company Name(Required)

Point of Contact for work:

First Name(Required)

Last Name(Required)

Email Address(Required)

What is the exact location of the work being performed?(Required)

To provide this information via files like screen shot of google maps, cross streets with detailed information, latitude / longitude coordinates with detailed information, please type "See Files" in the above box use the field below to upload your documents.

Work Location Files

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Max. file size: 100 MB.

What kind of work is being performed at this location?(Required)

What are you looking for as far as Traffic Control?(Required)

What is the start date and expected duration that you will need traffic control?(Required)

What kind of work is this?(Required)

Doing Business As

Use this field if the business name is difference from the Company Name in the first page.

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Physical Address

If different than mailing address

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Fax

Other

Business Owners

Owner First Name(Required)

Owner Last Name(Required)

Owner Phone(Required)

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Billing Person First Name(Required)

Billing Person Last Name(Required)

Billing Person Email(Required)

Federal ID

UBI

The information disclosed in this form is for the sole purpose of obtaining credit and is warranted to be accurate. In completing this application, I/we authorize United Traffic Control Services to use this information to obtain billing information.

Terms: Invoices are due 30 days from billing date. Outstanding balances on invoices past 30 days will be assessed a finance charge of up to 24% on any outstanding balance. Outstanding balances past 60 days will result in services no longer being provided.

Note that in the event you fail to make a payment when due, this account will be referred to an outside collection agency for collection. In the event, the contingency fee assessed by the collection agency will be added to the principal balance, plus interest due. If collection action is necessary, you will also be liable for attorney fees accrued.

Applicants signature attest financial responsibility, ability and willingness to pay UTCS in accordance with the above terms and conditions. This is a legally binding contract between UTCS and said Contractor.

Name(Required)

Title(Required)

Date(Required)

Signature(Required)