Tel: 718.272.0206

Client Billing Information:

 
 
Contact Name: :: Billing contact person or department.
 
Street Address: :: Include city, state, and zip code.
 
 
 
 
Account Number: :: Enter your account or service agreement number (if available).
 




Payment Method :: Please select a payment method.
 

Service Request Details:

 
The following fields are only required if different from above.
 
Site Name: :: If different from above
 
Site Contact: :: If different from above
 
Site Address: :: If different from above. Include full city, state and zip code.
 
Contact Phone: :: If different from above.
 
Contact Email: :: If different from above.
 
Request Type: :: Please select the type of request.
 
Scope of Request: :: Please be as detailed about your request as possible. Include any system model informaiton as necessary.
 
System Model: :: If not listed above. Include all make and model information.
 
Response Time: :: Please choose a response time for this request. (See our rate table for hourly pricing information for on-site visits).
 
Upload a file: :: You may attach files to help us process your request such as pictures of existing equipment or audio files for account changes. (Compress multiple items in a .zip file)
 
Please review the above information before clicking submit! You will receive a confirmation email with your request information for your records. If you are having trouble submitting, scroll up and verify all required fields are filled in or click here: top of form.