DSS Service Request

1

Contact Name * This field is required.Your name or the name of your supervisor, business, etc we should use to follow up with your request.

Contact Name

2

Your Email* This field is required.Check your email for the verification code and enter the code below to continue.

example@example.com

Email Verified

The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification

••••

3

Phone Number* This field is required.Please enter a valid phone number we can follow up with if needed.

Area Code

Phone Number

4

Business NameName of your business. Optional.

Business

6

Enter Website URL(s) Below* This field is required.Copy/paste website or social media page URLs below for service. For multiple urls, hit TAB to skip a line or separate with commas (,)

7

Describe your request below * This field is required.Enter a brief description of your request below. Your agent will be forwarded this information

8

Request On Site Service Or Live ConsultationSelect your preferred appointment date. Your agent will follow up with your request

9

Login Request Information

Your new login in will be sent to the email address we have on file. Please verify the email address you have entered. If you have changed your email, please go back and select 'Other' and include your phone number so that we can verify your information

Your agent will typically follow up within 24 hours with your new login.