Partnership Questionnaire

• Company Info
• Company Name:  
• Physical Address:  
• Web Url:
• City:  
• State:  
• Zip:  
• 
  Service Contact Person
• Title:  
• Name:  
• Email Address:  
• Office Phone:  
• Mobile Phone:  
• 
  Office Contact Person
• Title:  
• Name:  
• Email Address:  
• Office Phone:  
• Mobile Phone:  
• 
  After Hours Emergency Contact
• Name:  
• Email Address:  
• Phone:  
• Mobile Phone:  
• Are you a member of a Union?  
  Yes
  No
• If yes, which Union?
  
• 
  Standard Business Hours
• CCTV Hourly Rate:  
• Data Hourly Rate:  
• Telco Hourly Rate:  
• Fire & Burg Hourly Rate:  
• Low Voltage Hourly Rate:  
• Networking Hourly Rate:  
• Delayed Egress Hourly Rate:  
• Minimum Hours:  
• Overtime Rate:  
• Travel Charge:  
• Travel Distance Without Charge:  
• 
  What metropolitan area(s) do you service?  
  
• Please check the services you are experienced with
  Low VoltageNetworkingCCTVDelayed Egress
  DataTELCOAccess ControlFire and Burglary
• Attach copies of all licensing (doc, docx, pdf formats only):
• Please include all copies of licensing if printing this application.
• If Delayed Egress, number of technicians?
  
• If Fire and Burglary, license number?
  
• List any specific brands of programs/systems that you might be qualified in such as Bosch, Nortel, etc.?  
  
• How did you hear about Coliant Solutions?
  
• Do you know anyone that currently works with us?
  
• Thank you for interest, please scan and email with your licensing documentation to Kim.Barth@CoLiantSolutions.com or mail a copy with your licensing documentation to our corporate head quarters Attn:Kathy Brautigam, 2703 Brickton North Drive, Buford, GA 30518