|
ANNUAL BILLING INFORMATION This WILL NOT appear online. | ||||||||||||
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: _____________
|
||||||||||||
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 Contacts Name: ____________________________________________________________________________________________ Contacts e-Mail Address: ____________________________________________________________________________________
Ambient Air Monitoring Capabilities? Yes .. No Geographic Testing Area:
__________________________________________________________________________________________________________ |
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: ______________________________________________________________ ____________________________________________________________________________________________________________
___________________________________________________________________________________________________________ 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: ____________________________________________________________________________________ __________________________________________________________________________________________________________
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
I authorize Emissions Schematics to bill my
credit card $500 (USD) for the annual fee. ActiveSET.org is owned
and Cardholder's
First and Last Name as it appears on the front of the card: |