Facilities Management Services Order Form

Business Name:*

Email*

Address:*

Street Address Address Line 2 City State ZIP Code

Date Requested:

Requestor's Name:*

Requestor's Contact Number:

Facility Location:

Facility Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Name:

Contact Phone Number:

Scope of Work:

Dispatch Priority Code:

Dispatch Priority Codes:
Priority codes are based on the urgency of the work requested and determine the response times and completion times expected of Contractors.

1=Emergency Response- Situations that may result in eminent physical danger to an employee, customer, or other’s life, health, or safety or in the inability to properly secure the Store.
Expected Completion Time (ECT): Within 4 hours or less*

2=Priority Response- Situations that immediately effect the Store or Stores operations and ability to service customers.
Expected Completion Time (ECT): Within 24 hours or less*

3=Standard Response- Situations that do not affect the immediate operations of the Store and pose no threat to life, health, safety –Miscellaneous maintenance repairs
Expected Completion Time (ECT): Within 5 Business Days or Less*

4=Next Visit/NTE 30- Situations have issues that are low priority and should be completed the next time the Contractor visits the site for scheduled maintenance or higher priority work orders. However, response should not exceed 30 days.
Expected Completion Time (EXT): Next visit not to exceed 30 days

*=If Contractor is unable to complete work for any reason with in the Expected Completion Time, Contractor is to provide an updated revised Estimated completions time to Credit Union.

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