Let’s Work Together

Name *

First Name

Last Name

Phone *

(###)

###

####

Best Time to Call

Morning

Afternoon

Evening

Late Evening (after 8pm)

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of Services Needed (select all that apply)

New Installation (new outlets, lighting fixtures, panel)

Repair/Troubleshooting (non-working outlets, circuit breakers tripping)

Upgrade (panel upgrade, service upgrade)

Renovation/Remodel (kitchen remodel, bathroom remodel)

Lighting (interior lighting, exterior lighting, landscape lighting)

Smart Home Integration (smart switches, thermostats)

EV Charger Installation

Generator Installation/Repair

Electrical Safety Inspection

Other

Preferred Date for Estimate

MM

DD

YYYY

Preferred Time for Estimate

Hour

Minute

Second

AM PM

I understand that submitting this form does not guarantee an immediate service appointment and that a representative will contact me to schedule a free estimate. I am aware that if this is a life threatening electrical emergency (possibility of electrical fire to property) that I am to contact Shane at 561-729-5848 for immediate assistance.