Work Order / Quote Request

Type Of Request:

I need Electrical Service
I need Generator Service
I want an Electrical Quote
I want a Generator Quote

Customer Details:

(Required fields are in RED. If a field is not applicable type NA)

Name:
Company:
Street:
City: State: Zip:
Main Phone:
Mobile Phone:
Pager:
Fax:
E-mail:

Job Details:

(If same as above type "same" or if not applicable type NA)

Your purchase order #:
Job name:
Your job #:
Job address:
City: State: Zip:
Job phone:

Additional Information:

Date work or quote must be completed?
If you are ordering service work, is this an emergency? YES NO
Is overtime authorized? YES NO
During what hours can we perform the work or quote?     --  

How do we obtain access to the job site?

Are Keys required? YES NO

Description of Work

  

 

  
 

16665 Racho Road, Taylor, MI 48180-5210 | 734.284.2100 | www.E-ZElectric.com
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