Questions? Please contact the Field Service Management Team at fieldservices@ussi.org or (321) 953-5212.























Business Information


Company Billing Address


Company Shipping Address


Company Contact Information Insufficient data of lack of an email address may hinder processing of paperwork


Organization of Business Tell use a litte about your business
Name Address Title Owernship Interest (%)
Tech Name City State Zip Code Contact Number Email Address


Territories and Capabilities The locations your service and your service capabilities
If available, please email an excel file of the ZIP codes you can cover to fieldservices@ussi.org.


Business Profile


Business References Please list at least three business references that we may contact if needed.
Name Address Contact Number


Certificate of Insurance
Please send in the Certificate of Insurance(s) meeting the requirements below to USSI via email to fieldservices@ussi.org or via fax to 321-727-3107.
Requirements for Commercial Work: General Liability $1M per Occurrence, General Aggregate $2M Per Project, Auto Liability (Commercial or Personal rated for Business Use) $1M - Approval required for lower limits, Workers Comp - if required by state (if exempt please provide exemption certificate if available)


Experience and Qualifications
Satellite Digital Signage TV Appliance
Satellite Digital Signage TV Appliance


State and Local Licenses


Certifications / Experience Please provide copies of all Certificates for Certifications below if available
Please provide copies of all Certificates for Certifications below if available


USSI Required Documents and Photos
Please upload the required documents below or send them to Field Services via email at fieldservices@ussi.org or fax at 321-727-3107.