Information Request Form
Please Complete This Form To Request Additional Information.
NOTE: Fields marked in RED are MANDATORY.
YES! We’re very interested in your Storage Structures.
We envision our initial application to be for your...
Dome-Style Structures Barn-Style Structures Fabric-Style Structures
First/ Last Name
Title
Company
Address 1
Address 2
City
State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip
Area Code Phone
Area Code Fax
Email
Approximate Tonnage of Salt / Sand Used per Winter? Please Select One 100 Tons - 250 Tons 251 Tons - 500 Tons 501 Tons - 1000 Tons 1001 Tons - 1500 Tons 1501 Tons - 2000 Tons 2001 Tons - 3000 Tons 3001 Tons - 5000 Tons 5001 Tons and Up
Number of Road Miles within Your Service Responsibility?
Is Land Allocated for Structure? Yes. No
Is a ‘Pad’ In-Place on Grounds? Yes. No
What is your Budget Allocation? Under $50K $51K - $75K $76K - $100K $101K - $150K $151K - $225K $226K - $300K $301K - $500K
What is your Projected Timetable? 0-3 Months . . . . 7-12 Months 4-6 Months . . . . Longer than 12 months
Would You PREFER to Load Inside Building? Yes. No
Within the Past Year,
Have You Been Cited by EPA for Groundwater Contamination? Yes. No
Other Types of Building (s) You’re Considering?
How Did You Hear of BULK STORAGE ?
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