GOPHER STATE ONE CALL MEMBER INFORMATION FORM

GSOC REGISTERED FACILITY OPERATOR INFORMATION FORM
Please complete all fields below as it relates to your Registered Facility Operator information with Gopher State One Call.

For questions, please email imap@gopherstateonecall.org or call 877-848-7472.
COMPANY INFORMATION
District Code(s):
Company Name:
Utility Type:

CablePhoneFiberElectricSewerTrafficGasWaterOther
Office Hours:
NOTE: 8am-5pm CT Mon-Fri is assumed
PRIMARY CONTACT INFORMATION
Contact Name:

First NameLast Name
Contact Phone:

Area CodePhone Number
E-mail Address:
Fax Number:

Area CodePhone Number
Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
TICKET DELIVERY INFORMATION
Select and fill one option only:
E-mail Address:
FTP Address:
Fax Number:

Area CodePhone Number
Other:
EMERGENCY CALLOUT INFORMATION
Work Hours -
Primary Number:

Area CodePhone Number
Alternate Number:

Area CodePhone Number
After Hours -
Primary Number:

Area CodePhone Number
Alternate Number:

Area CodePhone Number
Upon completion please sign, date and click submit to deliver your Registered Facility Operator information. Once Gopher State One Call has received your Registered Facility Operator information, we will begin testing your receiving locations by transmitting test tickets. These test tickets will be clearly marked with "TEST TICKET - NO LOCATE REQUIRED" in the Location of Work and Remarks fields. The Location of Work field will also provide instructions for confirming receipt of these tickets.
Signature:
Date:

MonthDayYear
Should be Empty:

GSOC REGISTERED FACILITY OPERATOR INFORMATION FORM

COMPANY INFORMATION

PRIMARY CONTACT INFORMATION

TICKET DELIVERY INFORMATION

EMERGENCY CALLOUT INFORMATION