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:

Cable Phone Fiber Electric Sewer Traffic Gas Water
Office Hours:
NOTE: 8am-5pm CT Mon-Fri is assumed
PRIMARY CONTACT INFORMATION
Contact Name:

First Name Last Name
Contact Phone:

- Area Code Phone Number
E-mail Address:
Fax Number:

- Area Code Phone Number

Mailing Address:

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

- Area Code Phone Number
Other:
EMERGENCY CALLOUT INFORMATION
Work Hours -
Primary Number:

- Area Code Phone Number
Alternate Number:

- Area Code Phone Number
After Hours -
Primary Number:

- Area Code Phone Number
Alternate Number:

- Area Code Phone 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:

- Month - Day Year
Should be Empty:

GSOC REGISTERED FACILITY OPERATOR INFORMATION FORM