CUSTOMER PROFILE + PROJECT DETAILS

Customer Profile

Company Name

Company Address

Your Name

First Name

Last Name

Your Phone Number

(###)

###

####

Your Email Address

Type of Company

Landlord

General Contractor

Electrical Contractor

Project Details

Project Location (City, State)

Project Name

When do you need fixtures delivered by?

Please provide a desired delivery date. We will try our best to work with manufacturers to accommodate.

Delivery Contact - Name

First Name

Last Name

Delivery Contact - Phone

(###)

###

####

Delivery address

Please provide the full address including City, State, and Zip

DELIVERY DAYS & HOURS

Lift Gate Required?

Please Note: Pallets of 8FT light fixtures will not fit a standard liftgate. You will need to have a forklift with extensions and a pallet jack with extensions onsite to assist with the offloading of these fixtures.

Yes

Additional Delivery Instructions

Additional Project Details

Terms & Conditions

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I HAVE READ & AGREE TO THE TERMS AND Conditions AND BY CHECKING THIS BOX YOU ACKNOWLEDGE THAT YOU ARE AUTHORIZED TO DO SO ON BEHALF OF YOUR COMPANY.