Member Change of Information Form

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Is your company/utility a member of Alabama 811?* This field is required.Members operate above and underground facilities, receive locate request tickets from AL 811, and locate lines.
YESNO
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Company/Utility Information* This field is required.If you do not know your member code, please type "unknown". If your membership includes more than one code, please enter all codes that you'd like us to apply the edits to.
Member Name
Member Code(s)
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Are you employed by or do you represent this company/utility Member?* This field is required.
YESNO
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You may be lost but we are here to help!* This field is required.If you were trying to update your AL 811 Portal Account information, log into the portal & select the excavator tab (left-hand side of the ticket entry screen). If your company/utility operates underground facilities and would like to become a member of AL 811 to receive locate requests, please fill out our application. If you are still lost and you'd like us to contact you, please enter your information below:
Contact Name
Best Contact Number
Email
Please type a summary of what you'd like us to help you with.
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Tell us who you are!Please provide your contact information. If we have any questions regarding your submission, we will contact you.
Contact Name
Position Title
Email
Office Phone Number
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When would you like these updates to take effect?* This field is required.
Date
Month
Day
Year
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Is this a permanent change?* This field is required.
YESNO
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Temporary Change* This field is required.When would you like us to revert back to your existing information?
Date
Month
Day
Year
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What brings you here today?* This field is required.Please select all that apply
Add, Edit, Replace an Individual Contact
Add, Edit, Replace how locate request tickets are received
Edit after hours/holidays emergency contacts
Update Observed 2022 Holidays
Update Address (Physical and/or Mailing)
Update Main Company Phone Number
Other
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You chose Add, Edit, or Replace an Individual Contact* This field is required.Please scroll down to choose an option from the list below
Add Contact
Remove Contact
Replace Contact (this will remove and add contact)
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Add ContactThis selection will only add a contact, not replace.
Contact Name
Position Title
Email
Office Phone
Cellphone
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Remove ContactThis selection will only remove a contact, not replace.
Contact Name
Position Title
Email
Office Phone
Cellphone
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Replace ContactThis selection will remove an existing contact, and replace them.
Contact for Removal
Contact to Add
Position Title
Email
Office Phone
Cellphone
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Which roles will this contact be responsible for?* This field is required.Select all that apply
Billing
Mapping Updates
Main Contact - Admin
Positive Response
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Which roles were they responsible for?* This field is required.Select all that apply
Billing
Mapping Updates
Main Contact - Admin
Positive Response
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Positive Response* This field is required.Select each facility you'll be posting ticket responses for:
Cable
Electric
Fiber
Gas
Petroleum
Phone
Pipeline
Sewer
Traffic
Water
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Mailing Address* This field is required.If your physical address differs from your mailing address, you can add it after this slide.
Street Address
Street Address Line 2
City
State
Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Address Type* This field is required.Is your company's physical address the same as the mailing address?
YESNO
19
Physical Address* This field is required.
Street Address
Street Address Line 2
City
State
Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
20
Invoice Preference* This field is required.How would you like to receive your invoices? (Select One Option)
Mailing Address
Physical Address
Email
21
You chose Add, Edit, or Replace Ticket Output* This field is required.Please scroll down to choose an option from the list below
Add Ticket Output Email (This will create an additional transmission fee per ticket)
Remove Output Email
Replace Ticket Output Email (this will remove and add)
Request Korterra Ticket Management System Demo
22
You chose to Add a Ticket Output* This field is required.AL 811 bills based on transmission, not ticket. By selecting this option, your bill will increase. If you would like to change your selection, please clear this card & click previous on the bottom left. For the purpose of this section, the phone number will only be used if the ticket transmission fails.
Email to Add
Phone Number
I approve the additional transmission fee
23
You chose to Remove a Ticket Output* This field is required.By selecting this option, you will no longer receive locate request tickets to the email you enter below.
Email to Remove
24
You chose to Replace a Ticket Output* This field is required.By selecting this option, you will remove a current email address & add a replacement to receive locate request tickets. For the purpose of this section, the phone number will only be used if the ticket transmission fails.
Email to Remove
Email to Add
Phone Number
25
After Hours/Holiday Emergency ContactsProvide up to 3 contacts. Courtesy calls for emergency locate requests will only occur outside of your business hours and on selected holidays. You will enter this criteria in the upcoming slides. (Please note that this update will override your emergency contact list if you currently have one in place.)
Primary
Primary Number
1st Alternate
1st Alternate Number
2nd Alternate
2nd Alternate Number
26
Hours of Operation -* This field is required.Are your operating hours the same each day Monday through Friday?
YESNO
27
Hours of Operation Monday Through Friday* This field is required.If you receive an emergency locate request outside of these hours, your designated contact(s) will receive a courtesy call.
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Hour
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Minutes
PM
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PM
Until
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Minutes
PM
AM
PM
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Hours of Operation (Varying Times)Enter operating hours for each weekday. Example: 8:00 AM - 5:00 PM. Open to Close Hours Only. Type zeros "00:00 AM - 00:00 PM" if you're closed a particular day.
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
29
Observed Holidays* This field is required.The preselected holidays are observed by AL 811 and these holidays will not count towards allotted time for positive response. Holiday Saturday = Observed Friday. Holiday Sunday = Observed Monday. If your company observes additional holidays, please select them to receive emergency locate call-outs.
New Years Day (AL 811)
MLK Jr. Day
Mardis Gras
Presidents Day
Good Friday
Confederate Memorial Day
National Memorial Day (AL 811)
Jefferson Davis Birthday
Juneteenth
Independence Day (AL 811)
Labor Day (AL 811)
Columbus Day
Veterans Day (AL 811)
Thanksgiving (AL 811)
Black Friday (AL 811)
Rosa Parks Day
Christmas Eve (AL 811)
Christmas Day (AL 811)
New Years Eve
30
Main Company Phone Number* This field is required.Please enter your updated phone number below. This will replace the main office number we have on file for your company.
Please enter a valid phone number.
31
Other* This field is required.If there were no update options that suited your needs, please provide your request details below. If we have any questions, we will contact you.
32
Additional details?Please type any details below that you'd like us to know about.
33
Alabama 811 will apply these changes as soon as possible unless specifically noted.* This field is required.AL 811 Operating Hours M-F 7:00 AM - 5:00 PM
By clicking here, I confirm I have read over and made any necessary comments.
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