Membership Application

Please Note! We have updated our online member application to simplify the process for new members. The new application can be found at:

New Member Application - 2021
Alabama 811 Membership Application
- Main Company Contact Person*
  
  First NameLast Name
- Email*
  example@example.com
- Company Name*
  Name
- Mailing Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Physical Address Same as Mailing?
  
  YesNo
- Physical Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Office Phone*
- Office Fax
- List the hours that your company will have someone available to monitor locate request delivery.
- 24 Hour Monitoring - select yes if the primary receiving device will be monitored and responded to 24x7
  
  YesNo
- Monday Open
  
  Hour Minutes
  
  AM/PM Option
- Monday Close
  
  Hour Minutes
  
  AM/PM Option
- Tuesday Open
  
  Hour Minutes
  
  AM/PM Option
- Tuesday Close
  
  Hour Minutes
  
  AM/PM Option
- Wednesday Open
  
  Hour Minutes
  
  AM/PM Option
- Wednesday Close
  
  Hour Minutes
  
  AM/PM Option
- Thursday Open
  
  Hour Minutes
  
  AM/PM Option
- Thursday Close
  
  Hour Minutes
  
  AM/PM Option
- Friday Open
  
  Hour Minutes
  
  AM/PM Option
- Friday Close
  
  Hour Minutes
  
  AM/PM Option
- Type of facilities operated - select all that apply:
  
  Cable TelevisionLong Distance CarrierElectricTelephoneFiberProduct PipelineWaterGas DistributionGas GatheringGas Interstate PipelineGas TransmissionSewerWater GatheringOther
- Preferred mode for receiving locate requests and daily audit reports
  
  E-MailFTPKorWeb Ticket Management
- Korweb is an advanced ticket management system provided to Alabama 811 members at no additional cost. More information can be found on our website. You will be contacted by a representative at Korterra to configure your account.
- Email for Delivery
  example@example.com
- Ftp Address
- Ftp Username
- Ftp Password
- Ftp Remote Directory
- SFTP
  
  YESNO
- Daytime Backup Person (if phone call is needed)
- Daytime Backup Phone
- Would you like to receive copies of locate requests placed by your company?
  
  YesNo
- Would you like Survey Requests sent to a separate receiving device in addition to your normal receiving device?
  
  YesNo
- Email Address
  example@example.com
- Phone Number
- Contact Person or Dept.
  Name
- Would you like emergency requests to be sent to a separate receiving device in addition to your primary receving device?
  
  YesNo
- Email Address
  example@example.com
- Phone Number
- Contact Person or Dept.
  Name
- This section is not required to be completed. This section should only be completed if you wish to receive a courtesy call letting you know that an emergency locate request ticket has been sent to your company outside of your normal hours of operation. In addition to this call, you will also be sent a copy of the emergency locate request by normal delivery.
- Would you like to receive emergency after hours calls for emergency locate requests?
  
  YesNo
- Primary Contact
- Phone
- Alternate Contact 1
- Alternate Contact 1 Phone
- Alternate Contact 2
- Alternate Contact 2 Phone
- May we provide this information to our callers?
  
  YesNo
- Authorized Contact Person for Notification Area Updates
  Name
- Notification Area Contact Email
  example@example.com
- Notification Area Contact Address Same As...
  
  Physical AddressMailing AddressNeither
- Notification Area Contact Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Notification Area Contact Number
- Billing Contact Person
  Name
- Billing Contact Email
  example@example.com
- Billing Contact Number
- Billing Fax
- Billing Address Same As...
  
  Physical AddressMailing AddressNeither
- Billing Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Would your prefer to receive your invoices by
  
  MailEmail
- Preferred billing frequency
  
  AnnualQuarterlyMonthly
- Name of person posting responses
- Cell Phone
- Email
  example@example.com
- Office Phone
- Type of facilities responding for - select all that apply:
  
  Cable TelevisionLong Distance CarrierElectricTelephoneFiberProduct PipelineWaterGas DistributionGas GatheringGas Interstate PipelineGas TransmissionSewerWater GatheringOther
- Add another user?
- Name of person posting responses
- Cell Phone
- Email
  example@example.com
- Office Phone
- Type of facilities responding for - select all that apply:*
  
  Cable TelevisionLong Distance CarrierElectricTelephoneFiberProduct PipelineWaterGas DistributionGas GatheringGas Interstate PipelineGas TransmissionSewerWater GatheringOther
- If you need to add more than two users please email Jennifer Pickle at jpickle@al811.com with a list of users and facilities so we can configure your account properly and make sure all accounts are properly created.
- Is everyone who will be submitting responses registered as a user of the Alabama 811 Web Portal?
  
  YesNoNot Sure
- Members not using Korweb or a custom locate manage software solution will need to be registered for the Alabama 811 Web Portal in order to post responses via the web portal or mobile app.
- Member Code
- 811 Responsible
- Meeting Date
  
  MonthDayYear
  Date
- Should be Empty:

Alabama 811 Membership Application