+1 905-799-1119
1-833-495-1300
info@gn-systems.com
 

 Contractor Sign Up Form

A) Company Information Address

Legal Company Name:
DBA (if different from above):
Registered Business Address:
City:
Province:
Postal Code:
Phone:
Fax:
GST/HST #:
PST/QST #:
WSIB/WCB Coverage:
Yes    No
WSIB/WCB account #:

B) Company Information

Type of Business:
Name of Person Responsible for Accounts Receivable:
Phone:
Fax:
Email:

Contact Information

Primary Contact:
Phone:
Direct:
Email:
Secondary Contact:
Phone:
Direct:
Email:

Type of Services Offered

Does your company provide Structured Cabling/Wireless services?
Yes    No
Does your company provide Fiber Optic Cabling services?
Yes    No
Does your company provide FTTH/FTTS, Fiber Splicing services?
Yes    No
Does your company provide AV/Projector services?
Yes    No
Does your company provide Digital/VoIP Telephony services?
Yes    No
Does your company provide CCTV services?
Yes    No
Does your company provide Electrical services (Electrical licence required)?
Yes    No

Emergency Service

Do you provide 7 day, 24 hour a week emergency service?
Communications
Yes    No
Electrical
Yes    No
Network Maintenance
Yes    No
Server Maintenance
Yes    No
AV/CCTV Maintenance
Yes    No
If you do offer 7/24-hour service, how is this delivered? Explain the process we would have to follow to contact one of your staff during an after hours service emergency: (Please attach a list of contact names and numbers).

Escalation Management

Please indicate internal contacts, titles and telephone numbers for escalation of customer concerns including after hours. Attach any processes or procedures of importance.
Name & Title
Telephone Number

Structured Cabling / AV / CCTV Technician - Rate

Days Times Rate
Monday - Friday 8:00 am to 5:00 pm $ / hrs
Monday - Friday; Saturday 5:01 pm to 7:59 am; 24 hours $ / hrs
Saturday 24 hours $ / hrs
Sunday 24 hours $ / hrs
Statutory Holiday 24 hours $ / hrs

FTTH/FTTS, Fiber Splicing Technician - Rate

Days Times Rate
Monday - Friday 8:00 am to 5:00 pm $ / hrs
Monday - Friday; Saturday 5:01 pm to 7:59 am; 24 hours $ / hrs
Saturday 24 hours $ / hrs
Sunday 24 hours $ / hrs
Statutory Holiday 24 hours $ / hrs

Electrical Technician - Rate

Days Times Rate
Monday - Friday 8:00 am to 5:00 pm $ / hrs
Monday - Friday; Saturday 5:01 pm to 7:59 am; 24 hours $ / hrs
Saturday 24 hours $ / hrs
Sunday 24 hours $ / hrs
Statutory Holiday 24 hours $ / hrs

Service Rates

Do you have a minimum hourly charge per service order/request?
Yes    No
If so, please indicate minimum hourly charge:

Service Call Travel charges

All travel expenses will be based on one round trip in one service vehicle following the established roadways/highways from Service dispatch location to the customer site.
Zone Distance - One-way (Round Trip) Dispatch Charge One Tech (Regular Hours)
0 0-50 km ( 0-100km) $
1 51-100 km (102-200km) $
2 101-150 km (202-300km) $
3 151-200 km (302-400km) $
4 201-250 km (402-500km) $
5 251-300 km (502-600km) $
6 301-350 km (602-700km) $
7 351-400 km (702-800km) $
8 401-450 km (802-900km) $
Meals per Day $ / tech
Do you have any other charges?
Yes    No
If Yes, Please specify:

Health & Safety Program

Health & Safety Program in your company?
Yes    No
PLEASE LIST BELOW THE HEALTH AND SAFETY CERTIFICATIONS AND PROVIDE COPIES:
WORKING AT HEIGHTS/FALL PROTECTION
Yes    No
WHIMIS
Yes    No
LIFT/BOOM TRAINING
Yes    No
FIRST AID
Yes    No
AWARENESS TRAINING (ONTARIO ONLY)
Yes    No
OTHERS:
Number of Technicians
Union or Non-Union
Yes    No

C) TERM

Currency:
Other(specify):
Credit Limit
Payment Term
Other(specify):

D) COMPLETED BY:

Date:
Name:
Phone:
Fax:
Email: