Electrical Contractor Work Order Form

Please fill out this form completely to request electrical services.

Customer Information

Name

    Email

      Phone Number

        Address

          Job Details

          Date of Request

            Preferred Service Date

              Job Location (if different from above)

                Type of Work

                  • Installation

                  • Repair

                  • Inspection

                  • Maintenance

                  Description of Work Required

                    Materials and Labor Estimate

                    Item/Service

                    Quantity

                    Unit Price

                    Total

                    Total Cost Estimate

                      Authorization

                      By signing below, I authorize the electrical work described above to be carried out.

                      Name:

                      Date:

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