BROUSS Elevators — Customer Account Form

✨ New Customer

Setting up a new account with BROUSS

🔄 Existing Customer

Updating your current account information

📋 You selected Existing Customer. Please fill in your current account number if you know it, then update any fields that have changed. Leave unchanged fields blank — we will only update what you provide.

Account Information

Basic account details

Property / Building Name *? Property name is required.

Building Type

Approx. # of Elevators / Escalators ?

Property Address

Physical location of the building

Street Address * Address is required.

City * City is required.

State

Zip * Zip is required.

County

📬 Add separate mailing/billing address (if different from property) ▼

Mailing Address

Main Contact (Primary)

Primary point of contact for this account

First Name * First name is required.

Last Name * Last name is required.

Title / Role ?

Company / Management Co.

Phone * Phone is required.

Mobile / WhatsApp

Email * Valid email is required.

Preferred Contact Method

Language Preference

English Spanish Both

Property Manager

If different from main contact — management company or individual

👤 Add Property Manager information ▼

First Name

Last Name

Management Company

Phone

Management Office Address

City

State

Zip

Billing Contact

Who receives invoices and manages payments

Same as Main Contact — use same name, phone, and email for billing

First Name

Last Name

Company Name

Phone

Billing Email ?

Secondary Billing Email

Billing Address (if different from property)

City

State

Zip

Invoice Delivery Preference ?

Preferred Payment Method

PO Required for Invoices? ?

Yes No

PO Number (if applicable)

Tax Exempt?

Yes No

Tax Exempt Certificate # (if applicable)

On-Site Contact

Person our technicians interact with on location

First Name

Last Name

Title / Role ?

Phone

Available Hours

Parking Available On-Site?

Yes No Limited

Building Access Notes ?

Secondary Contact

Optional — backup contact for this account

👥 Add Secondary Contact ▼

First Name

Last Name

Title / Role

Phone

Additional Authorized Contacts

Others authorized to receive information, approve work, or request service

🔑 Add Authorized Contacts (up to 3) ▼

These contacts are authorized to receive service reports, approve work orders, and communicate with the BROUSS team on behalf of this account.

Contact 1 — Name

Phone

Contact 2 — Name

Phone

Contact 3 — Name

Phone

Service Preferences & Emergency Info

Help our team serve you better

Preferred Service Hours ?

After-Hours Emergency Contact

Emergency Contact Phone

Special Access Instructions ?

Additional Notes