Application

 

    Contact Information

    Full Name
    Date of Birth
    Email
    Phone Number
    Address
    City
    State
    Zip Code
    Invoice Information (if different than above)
    YesNo
    Name of Accounts Payable Contact
    Address
    City
    State
    Zip Code
    Contact Email
    Contact Phone Number

    Company Information

    Company
    Job Title
    Website

    Employee Information

    Employee #1 - Full Name
    Email
    Phone Number
    Employee #2 - Full Name
    Email
    Phone Number
    Employee #3 - Full Name
    Email
    Phone Number
    Employee #4 - Full Name
    Email
    Phone Number
    Employee #5 - Full Name
    Email
    Phone Number
    Employee #6 - Full Name
    Email
    Phone Number
    Employee #7 - Full Name
    Email
    Phone Number
    Employee #8 - Full Name
    Email
    Phone Number
    Employee #9 - Full Name
    Email
    Phone Number
    Employee #10 - Full Name
    Email
    Phone Number
    May we publish your name, company, and website on our member directory, website and social media accounts? (Your personal information with remain private)
    YesNo

     

    General Information

    Which Shift Workspaces location are you joining?


     

    Vehicle Information


    License Plate Number

    Vehicle Make

    Vehicle Model

    Vehicle Color

     

     

    Release & Authorization


    At Shift Workspaces, we want to create the safest environment possible. As a part of our procedure for processing your application, investigative consumer reports may be prepared whereby information is attained through credit bureaus. By checking the box below, you waive any provision impeding the release of this information, and agree to provide any information necessary for the release of this information above and beyond that provided on this application. Shift Workspaces may refuse membership access because of any derogatory information contained in these consumer reports referenced above.


    By checking this box, I confirm I have read/agree to the terms of the above stated disclaimer.

    PLEASE CLICK "SEND" ONCE, THANKS.