Membership Application

Membership Application
- Company Name
  Name
- Main Point of Contact
  First Name, Last Name
- Job Title
- Main Contact's Phone
  Format: (000) 000-0000.
- Phone Type
- Extension
- Main Contact's Alt Phone
  Format: (000) 000-0000.
- Phone Type
- Extension
- Main Point of Contact's Email
  example@example.com
- Website
  www.website.com
- Company Mailing Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Physical Address Same as Mailing?
- Company Physical Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Type of facilities operated - select all that apply:
  
  Other
- Do you have digital, paper, and/or wall maps (even if they are outdated or incomplete) of the facilities selected above?
- List all facilities that have maps:
- Required - Select the preferred mode for receiving locate request tickets.
- Email Address
  example@example.com
- Contract Locate Company
  Company name
- Locate Company IT Contact
  Name
- Locate Company IT Contact Phone
  Format: (000) 000-0000.
- Locate Company IT Contact Email
  example@example.com
- FTP Address
- FTP Username
- FTP Remote Directory
- SFTP
- IT Contact
  First, Last
- IT Contact Phone
  Format: (000) 000-0000.
- IT Contact Email
  example@example.com
- Ticket Management System Name
- IT Contact
  Ticket management integration contact
- IT Contact Phone
  Format: (000) 000-0000.
- IT Contact Email
  example@example.com
- As a member, when you place a locate request within your own notification area as an excavator, you will receive an excavator email and a member email. Would you like to suppress the member notification for your own locate requests placed as an excavator?
- 24 Hour Monitoring - Select "Yes" if locate requests (emergency & non-emergency) will be monitored and responded to 24/7.
- Are your business hours the same Monday through Friday?
- Monday through Friday:
- Open
  
  :HourMinutesAM/PM Option
- Close
  
  :HourMinutesAM/PM Option
- Mon Open
  
  :HourMinutesAM/PM Option
- Mon Close
  
  :HourMinutesAM/PM Option
- Tues Open
  
  :HourMinutesAM/PM Option
- Tues Close
  
  :HourMinutesAM/PM Option
- Wed Open
  
  :HourMinutesAM/PM Option
- Wed Close
  
  :HourMinutesAM/PM Option
- Thurs Open
  
  :HourMinutesAM/PM Option
- Thurs Close
  
  :HourMinutesAM/PM Option
- Fri Open
  
  :HourMinutesAM/PM Option
- Fri Close
  
  :HourMinutesAM/PM Option
- Optional Service - Receive an additional notification by email for emergency locates placed during the operating hours selected above? (email address MUST differ from Section 3)
- Operating Hours Emergency Notification Email
  example@example.com
- Optional Service - Receive an additional notification by phone for emergency locates placed outside of the selected operating hours and on holidays?
- Primary Contact
- Primary Contact Phone
  Format: (000) 000-0000.
- Alternate Contact 1
- Alternate Contact 1 Phone
  Format: (000) 000-0000.
- Alternate Contact 2
- Alternate Contact 2 Phone
  Format: (000) 000-0000.
- The 9 pre-selected holidays below are observed by AL 811, and do NOT count towards the working day window for locate requests. All other holidays (if selected) are used for emergency call-out purposes only.
- Optional Service - Receive an additional notification by email for survey & design request tickets. (email address MUST differ from Section 3)
- Survey Request Contact
  First Name, Last Name
- Job Title
- Survey Request Contact Phone
  Format: (000) 000-0000.
- Phone Type
- Extension
- Survey Request Contact Email
  example@example.com
- Over time, utility infrastructure expands to serve more Alabamians.The contact below will have access to submit service area updates through the AL811 mapping portal.
- Mapping Contact
- Job Title
- Mapping Contact Phone
  Format: (000) 000-0000.
- Phone Type
- Extension
- Mapping Contact Email
  example@example.com
- Billing Contact
- Job Title
- Billing Contact Phone
  Format: (000) 000-0000.
- Phone Type
- Extension
- Billing Contact Fax
  
  Area CodePhone Number
- Billing Contact Email
  example@example.com
- Billing Address Same As...
- Billing Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Preferred Invoicing Method
- Preferred billing frequency
- Positive Response is a process to facilitate communication between utilities, excavators and Alabama 811, regarding the status of identifying and marking the underground facilities within the proposed area of excavation on locate request tickets.
  
  Responses will be submitted through the AL 811 Portal by the individual(s) entered below.
- Positive Response is a process to facilitate communication between utilities, excavators and Alabama 811, regarding the status of identifying and marking the underground facilities within the proposed area of excavation on locate request tickets.
  
  Since responses to locate requests will be submitted using an API. An AL811 representative will work with the IT contact below to configure and test positive response.
- Positive Response is a process to facilitate communication between utilities, excavators and Alabama 811, regarding the status of identifying and marking the underground facilities within the proposed area of excavation on locate request tickets.
  
  Responses to locate requests will be submitted by your contract locator. An AL811 representative will work with the IT contact below to configure and test positive response.
- Positive Response is a process to facilitate communication between utilities, excavators and Alabama 811, regarding the status of identifying and marking the underground facilities within the proposed area of excavation on locate request tickets.
  
  Responses to locate requests will be submitted through your ticket management system interface. An AL811 representative will work with the IT contact below to configure and test positive response.
- Contract Locate Company
- Locate Company IT Contact
  Name
- Locate Company IT Contact Phone
  Format: (000) 000-0000.
- Locate Company IT Contact Email
  example@example.com
- IT Contact
  Name
- IT Contact Phone
  Format: (000) 000-0000.
- IT Contact Email
  example@example.com
- Ticket Management System Name
- IT Contact
  Ticket management integration contact
- IT Contact Phone
  Format: (000) 000-0000.
- IT Contact Email
  example@example.com
- Positive Response Contact
- Job Title
- Positive Resp. Contact Phone
  Format: (000) 000-0000.
- Phone Type
- Extension
- Positive Resp. Contact Alt Phone
  Format: (000) 000-0000.
- Phone Type
- Extension
- Positive Response Contact Email
  example@example.com
- Type of facilities operated - select all that apply:
  
  Other
- Registered as a user on the Alabama 811 Web Portal?
- Add'l Positive Response Contact
- Job Title
- Add'l Positive Resp. Contact Phone
  Format: (000) 000-0000.
- Phone Type
- Extension
- Add'l Positive Resp. Contact Alt. Phone
  Format: (000) 000-0000.
- Phone Type
- Extension
- Add'l Positive Response Contact Email
  example@example.com
- Type of facilities operated - select all that apply:
  
  Other
- Registered as a user on the Alabama 811 Web Portal?
- Member Code
- 811 Responsible
- Meeting Date
  
  MonthDayYear
  Date
- Should be Empty: