Emergency Service Authorization

First Name *

Last Name *

Job Title *

Company *

Email Address *

Brief description of the issue (optional)

Emergency Service Rates

Service	Tier 1	Tier 2	Tier 3	Minimum
Remote support	$150/hr	$125/hr	$100/hr	1 hour
Onsite support	$210/hr	$160/hr	$160/hr	4 hours
Travel fee	$80/hr	$80/hr	$80/hr	2 hours
Coordination fee	$150	$125	Waived	n/a
Same or next business day response fee	$250	$150	Included	n/a

I am authorized to approve billable work on behalf of this organization *

Yes

I understand this work is not covered by a service agreement and will be billed as emergency time and materials at the rates shown, with travel and parts billed separately

Yes

Type your full name as your electronic signature *

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