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Crisis Services - Immediate Response

PRE-REGISTER & BE PREPARED FOR IMMEDIATE RELIEF IN ANY CRISIS

register now and receive your free membership card
print a form to mail in	register online
Many City, State or County agencies have the foresight to pre-register an emergency account with Diamond. Pre-registering any entity is free and takes only a few minutes. Be prepared, pre-register today. Diamond implores government and private entities alike, to take advantage of the simple, quick and free process.

PRE-REGISTRATION APPLICATION FOR EMERGENCY SERVICES

Please fill out this form as completely as possible.
Your completed application will save valuable time when placing your emergency order.

*Entity:

*Contact:

Title:

*E-mail:

*Phone:

Fax:

,	,
Physial Address	city	state	zip

Indicate any/all of the following equipment, supplies & services you may require in the event of an emergency:

Portable Restrooms	Pumping Services	Recycle Boxes w/Liners
Hand Wash Stations	Generators / Pumps	Non Potable Water
Restroom Trailers	Temporary Fence	Potable Water
Shower Trailers	Barricades	Bottled Drinking Water
Holding Tanks	Refuse Boxes w/Liners	Other:
Temporary Power	Generator Rental

We will never share, sell, or rent the information provided us with anyone without your advance permission or unless ordered by a court of law. Information submitted to us is only available to employees managing this information for purposes of contacting you or providing contracted services / equipment.

Please provide contact names and telephone numbers we should have on file:

Emergency Contact Name:	Mobile #:
Emergency Contact Name:	Mobile #:
Emergency Contact Name:	Mobile #:

Additional Billing Information:

Purchase Order Required For Payment? Yes No

Optional Emergency Services Purchase Order:

NOTE: Any Purchase Order Submitted For Emergency Services
May Only Be Applied To Emergency Situations

Additional Comments:

By clicking the submit button, I am authorizing Diamond Environmental to establish a pre-registered emergency account for the above entity. I understand this offer is absolutely free.

Simplicity Reliability Personal Attention

~ Southern California's Premier Provider ~
Portable Toilets Hand Wash Stations Temp Fence Dumpsters Storage Containers
Pumping Services Restroom Trailers Shower Trailers Barricades Disaster & Emergency Services