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
icon-printprint a form to mail in icon-formregister 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.








    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.