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Company Name: *
Position: *
First Name: *
Last Name: *
Email Address: *
Street Address: *
City: *
State: *
Zip: *
Business Phone: *
Comments:
Abilities / Skills:
Coverage Areas:
(select all that apply)
*
 Cuyahoga County (Downtown) 
 Cuyahoga County (East) 
 Cuyahoga County (West) 
 Geauga County 
 Lake County 
 Lorain County 
 Medina County 
 Summit County (Akron) 
 Summit County (Suburbs) 
Number of Available
Trucks:
*
Sidewalk Work?
 Yes 
 No 
Deicing Services?
 Yes 
 No 
Types of Equipment Available
(select all that apply):
 4 WD Backhoe Loaders 
 Skid-Steer Loaders 
 3 yard Bucket Loaders 
 5 yard Bucket Loaders 
List Other Equipment Available
(be specific):
List Service Experience
(be specific):
*
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Abraxus Snow and Ice Management is always looking for qualified sub-contractors to provide winter weather services. Please fill out the information below in order to be considered for employment.   * Denotes required information.
©2013 ABRAXUS SNOW AND ICE MANAGEMENT   P.O. Box 30550    Cleveland, OH 44130    Phone: 216-321-SNOW (7669)