Abacus Referral Form

ABACUS REFERRAL PORTAL

Submit Abacus Customer Information Here. IF SUBMITTING AFTER HOURS, PLEASE CALL 713-338-2424 TO NOTIFY!
Our Team at BIONIC Emergency Services would like to say "Thank You" for your support, and for trusting us to offer world-class customer service to your valuable client!
Todays Date - Time of Submission
Customer Referral Details:

Complete Customer Information
Customer Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Customer E-mail (Not Required)
Customer Primary Number
Format: (000) 000-0000.
Customer Secondary Number
Format: (000) 000-0000.
Additional Contact Number
Format: (000) 000-0000.
What Did Customer Say Caused Water Damage? (Check as many as apply)

Other
What Did Customer Say Was Affected

Other
Enter Day & Date Abacus is Scheduled:
Check Any That Apply

Other
Additional Information:
Tech Assigned if known

First NameLast Name
Tech Cell
Format: (000) 000-0000.
Your Contact Info:

Let us Know Its You That Submitted Job Info to BIONIC :)
CSR Name

First NameLast Name
CSR E-mail
CSR Cell Phone/Text
Format: (000) 000-0000.
Thank you for submitting the above information to us. Upon receipt, we will reply to your email with a confirmation of receipt, and we will immediately begin to contact your client.

If you have any questions, or if you are submitting to us after-hours, please call our dispatch line at 713-338-2424.

We appreciate your support!

Respectfully,

Shane & Wendi Dodson and the entire Team
at BIONIC Emergency Services

Shane Dodson
281-513-5594 Cell/Text
shane@bionic24365.com
Should be Empty:

ABACUS REFERRAL PORTAL

Customer Referral Details:

Your Contact Info: