Crisis Services – Immediate Response emergency_services_regis_card_front

PRE-REGISTER & BE PREPARED FOR IMMEDIATE RELIEF IN ANY CRISIS
register now and receive your free membership card
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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.








Physical 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
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:






Additional Billing Information:
Yes
No

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

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.