Service Request Form (South)

Service Type*

Select the Service Type being requested on the dates below.

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

Electrical Contracting Company Name*

Site Contact Name*

Site Contact Email*

Site Contact Phone*

Project Manager Name

Project Manager Email

Project Manager Phone

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

Requested Service Date 2

Select the start date

Requested Service Date 3

Select the start date

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.

File Attachments

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