Service Application Application for servicers wishing to work on Lacanche ranges for Art Culinaire. Company Legal Name* Trade Name Business License # State(s) Mailing Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Shipping Address same as Mailing Address Shipping Address Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Other Address Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Main Phone*Other PhoneFaxText PhoneDate the business started How long at present location Owner Name* Owner PhoneOwner Email* Owner Text PhoneService Contact* Service Phone* Service Email* Service Text PhoneAccounts Payable Contact Accounts Payable PhoneAccounts Payable Email Accounts Payable Text PhoneOwner preferred contact method Phone Text Email Service preferred contact method Phone Text Email Accounting preferred contact method Phone Text Email Total Employees Number of Service Technicians Number of Qualified Electricians Number of Gas Technicians Uniformed Employees Yes No Background Checks Done Yes No Drug Tests Done Yes No How Many Trucks Are Trucks Logo/Lettered Yes No Do You Have an Airsled Yes No CommentsService InformationProducts Serviced Electric Ranges Gas Ranges Vent Hoods Products Installed Electric Ranges Gas Ranges Vent Hoods Brand Names ServicedBrand Names For Which Your Are CertifiedPrimary Areas/Cities/Counties/Zip Codes CoveredCoverage Determined By Service Radius Zip Code Area of Coverage* 15 mile radius 25 mile radius 50 mile radius Travel Outside Your Area How Far Do You Travel Outside Your Area Preferred Courier For Receiving Parts USPS UPS RatesRate structure* Flat fee Hourly Rate* Minimum trip fee Trip Fee Mileage fee beyond certain distance Mileage fee and distance
