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24-Hour Emergency Service
Certified GSA Supplier

Miami, FL  (786) 536-5588
Detroit, MI  (734) 287-4111

New Account Application

To set up a new account, please complete the form below:

First Name*
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Last Name*
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Email*
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Company Information

Company Name
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Address
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City
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State
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Zip code
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Country
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Phone*
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Fax
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Web http://
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Accounts Payable

Contact
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Phone
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Contact Email
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Check box if you use reference or job number.

The information below is not required but will help us serve you better.

What is the most convenient time to contact you?*
Please check what day(s) you would like to be contacted.

*
Please select time frame.

Preferred method*
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What brought you to ECS*
Please let us how did you hear about us. If other, please indicate below.

Please specify
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Comments*
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