CREATE SERVICE QUOTE REQUEST
 
BILLING INFORMATION:
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  : *
  : *
  : *
  : *
  : - *
 
  : *
  :
  :
 
* Field is required.

SERVICE LOCATION:
  :
  : *
  : *
  : *
  : *
  : - *
 
 :
 :
 :
 
* Field is required.


SWITCHES, LIGHTS & OUTLETS:
  Switches or Outlets:       Add       Fix
  Exterior Or Landscape Lighting:       Add       Fix
  GFCI Outlets:       Add       Fix
  Recessed Lighting:       Add       Fix
  Light Fixture:       Add       Fix
  Track Lighting:       Add       Fix
  Ceiling Fan:       Add       Fix
  Other:


PANEL BOX:
  Circuit Breakers:       Add       Fix
  Exterior Or Landscape Lighting:       Add       Fix
 
  Something Sparking
  No Power / Partial Power / Troubleshoot
  Aluminum Wiring RepairService / Panel Upgrades
  100A Service Upgrade
  200A Service Upgrade
  400A Service Upgrade
 
  Other:


APPLIANCE CIRCUITS:
  Dryer Outlet:       Add       Fix
  Range / Stove Outlet:       Add       Fix
  Furnace or A/C:       Add       Fix
  Attic Fan:       Add       Fix
 
  Other:


LIGHTENING STRIKE/SURGE:
  Lightning Strike
  Something Sparking
  No Power / Partial Power / Troubleshoot
 
  Other:


REMODELS:
  Basement
  Bathroom
  Kitchen
  Whole House
 
  Other:


GENERATORS:
  Stand-By Generator:       Add       Fix
  Generator / Transfer Switch:       Add       Fix
 
  Other:


VOICE / DATA:
  Voice / Data Cabling:       Add       Fix
  Cable TV:       Add       Fix
 
  Other:


BACKYARD:
  Fountain:       Add       Fix
  Hot Tub:       Add       Fix
  Pool:       Add       Fix
 
  Other:


JOB INFORMATION:
  Status:
  Start Date: select date
  Completion Date: select date
  Call Before On-Site Visit?:
  Is this an emergency?:


 
© 2008 Dearinger Electric. Dearinger Electric is an equal opportunity employer.
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