Get Enrollment Form (page 1 Of 2) - Pers

Filling out the Enrollment Form (Page 1 Of 2) - Pers online is an essential step for registering your emergency response information effectively. This guide provides you with clear and concise instructions to complete the form accurately for each branch office.

Follow the steps to complete your Enrollment Form with ease.

1. Click ‘Get Form’ button to access the Enrollment Form. This will enable you to view and fill out the necessary fields required for your registration.
2. Enter the name of your company in the designated field. Make sure to provide the official registered name to ensure accurate documentation.
3. Fill in the name of your correspondence person. This should be the individual who will be the primary contact for all communications regarding the enrollment.
4. Provide the complete street address of your physical location, including the city, state, and zip code.
5. If your mailing address differs from your physical address, fill in the mailing address or P.O. Box number, along with the corresponding city, state, and zip code.
6. Input your business phone number and fax number in the appropriate fields, followed by the email address for further correspondence.
7. List the accounts payable contact's phone number and email address. This information is crucial for billing purposes and related inquiries.
8. In the emergency contact section, fill in the names and contact details for up to five emergency contacts. Ensure to include their phone numbers for immediate access during emergencies.
9. Indicate your preferred hazardous materials clean-up company and their contact number.
10. Select the type(s) of coverage that apply to your location from the available options. This section is vital for understanding the protections you will be granted.
11. For each branch office where specific services are desired, repeat the process to complete additional pages of the form as needed.
12. Review all entered information for completeness and accuracy before submitting. Once verified, you can save the changes, download or print the form for your records, and share it if necessary.

Complete your Enrollment Form online to ensure efficient handling of your emergency response information.