HelmCo Work Order Request

HelmCo Work Order Request

Thank you for choosing HelmCo Electric, Inc. for your electrical needs. Please fill out the below form. By submitting this request, you hereby agree to the following Terms and Conditions. HelmCo Electric is not responsible for the following, including but not limited to: patching or painting of finished surfaces, permit fees, engineering fees and unforeseen conditions. For a 2024 Service Call Price List and W9, please email Laurie@HelmCoElectric.com.
Date of Request*

MonthDayYear
Company Name*
Customer Name Authorizing Work*
Email Address*
example@example.com
Service Address*

Street Address

Suite / Unit

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Priority

LowMediumHighEmergency
Building Access Instructions (if applicable)
Description*
File Upload

Cancelof
Are you a new customer or an existing customer?*

New CustomerExisting Customer
New Customer Form and HelmCo W9
Legal Customer Name*
c/o (if applicable)
Property Management Company (if applicable)

Name

Street Address, Suite / Unit

CityState / Province

Postal / Zip Code
"Bill To" Address*

Name

Street Address, Suite / Unit

CityState / Province

Postal / Zip Code
Contact Name*
Phone Number*
Please enter a valid phone number.
Invoice Submission Email Address*
example@example.com
Notes
By signing the below, HelmCo Electric, Inc. is hereby authorized to submit invoices for electrical services provided to the above-mentioned customer. The customer agrees to make payment to our Accounting Department no later than thirty (30) days from the date of the invoice. You can reach our Accounting Department at Laurie@HelmCoElectric.com or (949)872-2155. Thank you for your business.
Agreed and Acknowledged,*

Clear
Date*

MonthDayYear
Date
Please download our 2024 Price List and W9 below for your records.
Should be Empty:

HelmCo Work Order Request

New Customer Form and HelmCo W9