Service Request Form

   Prior to filling out any information be sure that your home was built 1973 or newer.

   Be sure you have no common walls such as a condo with adjoining units.

   Priority Electric works on Beautiful, Detached Homes, 1973 or newer, only.

   Priority Electric operating hours Monday - Friday 8-4  ( holidays and rainy days excluded )

   Priority Electric works on Electrical and Lighting only. We do not install cable TV, telephone, speakers etc.

   Fill in the information, and hit "submit" at the bottom of this form.

   The more information we have, the better we can help you.

   Priority Electric will email and call you, after we receive this request for service form to confirm your
   appointment within 1 business day.

First Name:
  
 
Last Name:
     
Spouse's First Name:
        
Address:
  
 
Zip Code:
  
 
City :
  
 
Gate Code:
  
 
Home Phone:
  
 
Cell Phone:
  
 
Work Phone:
     
Fax:
     
Email Address:
  
 
Year Home Built:
    
Square Feet of Home:
    
Number of Electrical Panels:
    
     
Have you ever had an Electrical Contractor Perform an Inspection?



 
     
How did you hear about us?     
     
I am requesting:
 Estimate   This is for an estimate only and no work is to be performed. This is for new installations only! This is not for repairs!  
I am a prior client of Priority Electric
  Yes
  No
     
I am requesting:

Repairs   This is for having repair work done. I understand I can have a free estimate for additional work while Priority Electric is in my home. I understand Priority Electric charges $100/hour plus parts and does not estimate repairs.

 
     
I am requesting:
 Installations   This is for having installation work done. Not an estimate. I understand I can have a free estimate for additional work while Priority Electric is in working in my home.
 
   
   


Preferred Appointment Day and Show up Time

Please check-off the  following days and times that would work best for you.

Appointments will be confirmed by a Phone Call and eMail Within 1 Business day.
1st Choice for Appointment show up Day, Time, Date Monday Tuesday Wednesday Thursday Friday
9-10     10-12     11-2          1-4     All Estimates are between 8am-9am only.
 
2nd Choice for Appointment show up Day, Time, Date Monday Tuesday Wednesday Thursday Friday
9-10     10-12     11-2          1-4     All Estimates are between 8am-9am only.		  
I would like a courtesy phone
call 1/2 hour prior to visit:		 Yes No    Please call    
   
I would like to add the following information:  

All Repairs / Troubleshooting are done on Time and Material Basis!

Office 310-456-7999     Fax 1-800-569-8845      Email Harold@PriorityElectric.biz

 
 
 
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