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Technician Resource Center

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Technicians Registration Form

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First Name *

Last Name *

Company Name

Address 1

Address 2

Address 3

City *

State *

Zip Code *

Country *

Telephone Number *

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Mobile ( Primary )*

Mobile ( Secondary )

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Work Location:

Enter the postal zip code of your preferred service area. *
Enter the number of free miles you are willing to travel to job location. We will negotiate travel pay with you on jobs outside of this area. *
You may optionally enter some additional postal zip codes of your preffered service area[s]. (Optional) Note: Only used if you have another office outside the coverage area of your previous zip code.
1. 2. 3.
Enter number of free miles you are willing to travel from your alternate location. We will negotiate travel pay with you on jobs outside of this area. (Optional)
Enter the postal zip code of the service area[s] where you would prefer not to work. (Optional)
1. 2. 3. 4. 5.

Availability:

Please enter the hours below that you are available to provide assistance to a potential new client each day.

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How To Reach Me

Type in the best way for a client to reach you and estimate your response time.
During Available Hours *
During UnAvailable Hours *

Type Of Support *

Operating Systems *

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Applications

Select up to 30 hardware and/or software applications to provide assistance and support with.
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Certifications And Accomplishments

List your Training and Certifications. *
Enter your requested hourly rate *	$

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