*Office use only
First & Last Name


Company Name


Billing Address


E-mail Address


Area Code & Phone Number

Type of Company

Industrial Transportation Distribution Oilfield Other

Place Order for Staff (optional)

Would you like to request staff at this time? (check if yes)
Number of personnel required: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 50+

Please indicate the type of personnel required. (check all that apply)

	General Labour	Trades	Assembly		Class Drivers
	Refinery/Shutdown	Maintenance	Machinery		Forklift Drivers