* First Name

* Last Name

Company Name

Please provide us with your service address (your base)

* Street Address

Address Line 2

* City

* State

* Zip Code

* Is your mailing address the same as your physical address?

Yes

No

* Mailing Address

Address Line 2

* City

* State

* Zip Code

Office Phone Number

Home Phone Number

* Mobile Phone Number

* Email Address

Alternate Email Address

* What is your service range (in miles)?

* Are you capable of storing spare parts?

Yes

No

* Do you have a smartphone or a laptop with an aircard, capable of accessing the internet and email while you are on a service call?

Yes

No

What hours are you available to take calls Monday - Friday?

* Start

* Finish

What hours are you available to take calls Saturday - Sunday?

* Start

* Finish

Please attach your general liability certificate if available. (Max file size 1mb)

Please tell us about your capabilities

* Networking

* Digital Signage / Menu Boards

* Point of Sale

* Printers

* Computer / Server

	Install	Repair	N/A
Battery
CD / DVD
Complete System
Display
Hard Drive
Internet Connectivity
Memory
Motherboard
External Hard Drive
Scanner
Power Supply
Rack / Cabinet

* Security

* Telephony

* Cabling

What certifications do you hold?

Select all that apply

Special Certifications

	What type?
Cisco
CompTIA
Crestron
Dell
HP
Infocom
Microsoft

What tools do you have available?

* Select all that apply

Terms and Condition

Click here to view the terms and conditions that you must agree to prior to receiving calls from Tech Advantage.

* Do you accept the terms and conditions for working with Tech Advantage?

Yes

No

* I agree that I have attached my Certificate of General Liability Insurance, or will provide to Tech Advantage within three (3) business days.

Yes

No

* I agree that I will complete and send a Form W-9 (click here to obtain blank form) within three (3) business days to Tech Advantage.

Yes

No

* Indicates Response Required

	Install	Repair	N/A
Broadband Connection
Media Server
Router / Hub
Wireless Network

	Install	Repair	N/A
Flat Panel TV: On Wall
Flat Panel TV: Table Top
Smart Board
Projector

	Install	Repair	N/A
Complete System
Bar Code Scanner
Kiosk
Receipt Printer
Register
Signature Capture
Touch Screen Display
ATM

	Install	Repair	N/A
Dot Matrix
Inkjet
Laser
Line Printer
Multifunction All-in-One
Thermal

	Install	Repair	N/A
Access Control System
Alarms
Closed Circuit TV
Cable / DSL Modem
Firewall / Security
Switch
Hub
T1 Line
VPN

3Com	Aruba
Avaya	Bicsi
Extreme Networks	F5
IBM	Juniper
Lexmark	Linux
Microsoft	Novell
Xerox	Other

"E" Ring Pliers	9 pin serial cable	Adjustable crescent wrench
Butt Set	Cable Tester	Cell Phone
Console Cable	Crimpers	crossover cable
Digital Camera	Digital Multi-Meter	Drill
Driver Magnetizer	Fishtape	Flashlight
Ladder	Laptop	Magnetic Pen
Needle Nose Pliers	Patch Cable	Punch Down Tool
Push Rods	Reg. Pliers	Screwdriver Set (12)
Set Metric and Standard Allen\Hex elbow\bent	Set Metric and Standard Allen\Hex keys with extensions	Set of "Small" jewelers screwdrivers
Set of jewelers files	Small Container for Screws	Small Hammer
Snake	Soldering Iron	Spring Hook
Tone Generator	Vise Grips (Curved Nose)	Vise Grips (Long Nose)
Wire Cutters