Service Request Form

Please fill out all required fields.

Project / Site Address

Project Name

This number is listed on lighting controls shop drawings and is formatted similar to this 18-12345

Key Contacts for Electrical Contractor

Please provide key contact information for the actual project site, not office personnel or the distributor.

Electrical Contracting Company Name

Site Contact

Site Contact Email

Site Contact Phone

Project Manager Name

Project Manager Email

Project Manager Phone

Requested Service Dates

Service lead time is 10 business days. Please take this into account when selecting your requested service dates.

Requested Service Date 1

Select the start date

mm/dd/yyyy

Requested Service Date 2

Select the start date

mm/dd/yyyy

Requested Service Date 3

Select the start date

mm/dd/yyyy

Site Requirements

PPE Required

Tell us if PPE (Personal Protective Equipment) is required. PPE is Hard-hat, Safety Vest, Safety Glasses.

Background Check Required

Tell us if a background check is required

Additional Comments

If you have any special instructions or comments please share them with us.

Upload any related documents (optional)

Drop your files here

BY CHECKING THE BOX BELOW YOUR COMPANY AGREES THAT ALL THE LIGHTING CONTROL EQUIPMENT WILL BE COMPLETED INSTALLED AND WIRED, AND THAT OUR TECHNICIANS WILL HAVE COMPLETE ACCESS TO THE SITE DURING OUR SCHEDULED VISIT. IF OUR WORK IS DELAYED DUE TO INCOMPLETE INSTALLATION OR LIMITED ACCESS, ADDITIONAL CHARGES WILL APPLY.

CANCELLATIONS MUST BE RECEIVED THREE (3) BUSINESS DAYS PRIOR TO CONFIRMED STARTUP START DATE.

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