Name
*
First Name
Last Name
Company
Email
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example@example
Phone Number
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-
Area Code
Phone Number
Do you work with an electrical Distributor?
Designated Pollart Salesperson
First Name
Last Name
Due Date
*
-
Month
-
Day
Year
Date
Project Name
*
Project Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Application (Office, Warehouse, Manufacturer)
Foot Candle Target/Required
New or Retrofit
New
Retrofit
Economy or Standard Fixture? (Economy are used for price sensitive projects)*
Economy
Standard Fixtures
Specific Fixture you'd like to use?
Ceiling Type (Surface, Recessed, Etc.)
Dark Sky Required
Yes
No
Special Requirements: (Special Requirements: (Township, AHJ, Max Heights, Light Spill Max, etc.)
Max Mounting Height (i.e. Max Pole Heights, Min/Max Levels, etc.)
Project Description: (Use of Space, Desired Product, Any Other Important Information)
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