Reurn To HomeStack Testing Firm Directory Profile - Annual Fee $500 USD
For Firms With One Or More Office Locations
Mailing & faxing instructions are included below.
Important - Write Clearly or Type In
ANNUAL BILLING INFORMATION This WILL NOT appear online.

Do you have a paid Basic or Premium
listing on ActiveSET.org right now?
No, this is a new order.
Yes, we want to upgrade to a Directory Profile. Please prorate our
current account with an extended annual renewal date.





Send our receipt and placement confirmation to this e-Mail address:

___________________________________________________________________________________________________________
(This address will NOT be given, sold or leased to 3rd Parties)


Billing Street or P.O. Box: ___________________________________________________________________________________


City: ______________________________________________________________ State/Prov: ____________ Zip: _____________


Free Logo
Preparation:
Scan our logo from our website
We are sending a digital logo attached to e-Mail addressed to webmaster@activeset.org
We are mailing a scannable color logo with our order (artwork cannot be returned)
DIRECTORY PROFILE INFORMATION This WILL appear online.
Main Office Listing

Company Name: ____________________________________________________________________________________________



Street Address: _____________________________________________________________________________________________


City: ______________________________________________________________ State/Prov: ____________ Zip: _____________


Mailing Address (If different): _________________________________________________________________________________


City: ______________________________________________________________ State/Prov: ____________ Zip: _____________



Each of your additional offices will be given a FREE Premium Directory Listing:
I have attached addresses for additional office location(s). ... N/A, we have only one office location.


Phone (Area code): ______________________________________ Fax (Area code): ____________________________________


Toll Free: ___________________________________________________ or
N/A


Web Address: http:// ________________________________________________________________________________ or
N/A


Contact’s Name: ____________________________________________________________________________________________


Contact’s e-Mail Address: ____________________________________________________________________________________


Year Established: _____________
Testing Staff Size: _______________
No. of V.E. Readers __________

Ambient Air Monitoring Capabilities? Yes .. No

Geographic Testing Area:
U.S. & International
U.S. Only.
Canada Only
Limited Area (enter states/prov. below)

__________________________________________________________________________________________________________

U.S. EPA Testing Capabilities: All Methods Listed .. Selected Methods Only
1-4
5
5A-H
6
6A-C
7
7A-E
8
9
10
10A-B
11
12
13A-B
14
15
15A
16
16A-B
17
18
19
20
21
22
23
24
24A
25
25A-B
26
26A
27
28
28A
29
101
101A
102
103
104
106
108
111
201A
202
301
306
 
SW-846 Methods
BIF Methods
NIOSH Methods

Add'l U.S. EPA Methods: _____________________________________________________________________________________


Add'l Gaseous Monitoring Parameters/Specialties: ______________________________________________________________


____________________________________________________________________________________________________________

On-Site Sample Analysis/Titration:
Pm
SO2
Pm10
HCl
Hg
Other - List below:

___________________________________________________________________________________________________________


Industries Served:
All Industries - Asphalt, Soil Remediation, Cement, Manufacturers, Food & Beverage, Pulp & Paper, Power Generation,
Medical and Municipal Waste Incinerators, Petroleum/Fuel, Printing and Packaging, Sugar Mills.


Add'l Industries: ____________________________________________________________________________________________


These Industries Only: ____________________________________________________________________________________


__________________________________________________________________________________________________________


Gaseous Monitoring Dilution System? Yes .. No
No. of Mobile Labs: _______
No. of Isokinetic Sampling Trains: _______

Is your stack testing firm accredited as an Air Emission Testing Body (AETB)
to the ASTM D7036 competency standard?
Yes (Interim or Final Accreditation)    No
Enter One (1) Employee's Qualified Source Testing Individual (QSTI) Certification No.:
_______________(Example: 2010-123)

QSTI's First Initial: _____    QSTI's Last Name: _____________________   Note: This information will not appear on ActiveSET.org.


Provide a short paragraph describing your COMPANY OVERVIEW:










Provide a short paragraph describing your COMPANY EXPERTISE:











Provide a short paragraph describing your COMPANY SPECIALTIES:









PAYMENT OPTIONS The annual fee is non-refundable after your order has been placed on ActiveSET.org.

OPTION 1 - Pay By Check
Mail the completed form with a U.S. Check or Money Order in U.S. Funds for the $500 annual fee payable to:
ActiveSET.org 3335 NW 47th Terrace Gainesville, Florida 32606

OPTION 2 - Pay By Credit Card
Mail the completed form to:
ActiveSET.org 3335 NW 47th Terrace Gainesville, Florida 32606
Fax the completed form to:
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I authorize Emissions Schematics to bill my credit card $500 (USD) for the annual fee. ActiveSET.org is owned and
operated by Emissions Schematics. Your credit card will be billed as "Emissions Schematics"

Cardholder's First and Last Name as it appears on the front of the card:


____________________________________________________________________________________________


Credit Card Number:


____________________________________________________________________________________________



Expiration Date - Month: _____________ .. Year: __________

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