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952-881-0896

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952-881-0896
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New Customer Form

Please fill out the form below to ensure that we have correct information.

*Please note that all new accounts will need to pay their first service invoice before any additional work can be scheduled.

NAME

Legal Company Name(Required)

DBA Name (If Applicable)

Primary Contact Name(Required)

Primary Contacts Phone Number(Required)

Primary Contacts Email(Required)

PHYSICAL ADDRESS

Street Address City State ZIP Code

Do you have more than one (1) location that will require servicing?

Yes

If so, how many locations will require servicing?

More than 5 (Please send locations separately)

Physical Address (Location #2)

Location Name (If Applicable) Street Address City State ZIP Code

Physical Address (Location #3)

Location Name (If Applicable) Street Address City State ZIP Code

Physical Address (Location #4)

Location Name (If Applicable) Street Address City State ZIP Code

Physical Address (Location #5)

Location Name (If Applicable) Street Address City State ZIP Code

Payable Contact & Mailing Address

Accounts Payable Contact Name(Required)

Accounts Payable Phone Number(Required)

Accounts Payable Email(Required)

Invoices will be sent to this email.

Billing Street, PO Box City State ZIP Code

Payment Terms

Net 15 is our standard.

Forms

Electronic payment available?

Yes

W-9 needed from Assured Security?

Yes

Certificate of Insurance needed?

Yes

If the company is tax exempt, please send ST3 form along with this completed form.

Upload ST3 Form Here:

Max. file size: 512 MB.

Form completed by

Title

Date

MM slash DD slash YYYY

How did you hear about us?

Email
952-881-0896
9905 Lyndale Ave S Bloomington, MN 55420
MON–FRI: 8 AM – 5 PM

Highly recommended for any project with awesome results.

–Michael, Twin Cities

We see you're looking for residential locksmith services. Our Minneapolis Lock & Key location takes excellent care of all our residential customers. Visit their website using the link below for information!

CLICK TO VISIT MINNEAPOLIS LOCK & KEY'S WEBSITE!

Door Access Control
Security Equipment
Office Locksmithing
Commercial Door Products
Our Company

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952-881-0896
9905 Lyndale Ave S, Bloomington, MN 55420
MON–FRI: 8 am – 5 pm

Door Access Control
Security Equipment
Office Locksmithing
Commercial Door Products
Our Company

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