New Customer Intake Form
Hello, welcome to Newma Power Systems. This form helps us capture your contact information, and site location and gives us a rough idea of the scope of work that you are entertaining us to help you with. First and foremost, our team would like to thank you for the consideration to work with us. Second, it is always our hope that all parties walk away happy with any transaction, feeling that they got good value and service from the many goods and services we provide. If you can take the time to fill out this form, the best that you can, it will allow us to get you set up in our system.
How did you hear about our services?
*
Please Select
Google
Web search
Facebook
Instagram
Referral, if a referred, please state the referrals name so we can thank them
Other
Industry, holiday promotional code.
Current running promotion is for winter 2023 & 2024 discount for any Commercial, Industrial or Agriculture electrical services. Enter the code above to receive our promotional pricing. Valid through until Feb 29, 2023
If you were referred to us can you please let us know who that person was, so we can thank them.
Customer Key Contact Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Site Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Billing Address (if different from site)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Name, if applicable
Business Phone Number, if applicable
Please enter a valid phone number.
Job Site Coordination Contact Name, if applicable
First Name
Last Name
Job Site Coordination Contact Mobile Phone Number, if applicable
Please enter a valid phone number.
Job Site Coordination Contact Email, if applicable
example@example.com
Accounts Billable Contact Name, if applicable
First Name
Last Name
Accounts Billable Contact Email, if applicable
example@example.com
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Customer Type
*
Please Select
Residential Home Owner
Commercial Contractor
Residential Contractor
Interior Designer
Business Owner
Industrial Business Owner
Agricultural/Farm
Project Type
*
Please Select
General Service Call
New Build
Residential Renovation
Commercial Tenant Improvement
Maintenance Contract/Operating Permits
Industrial
Help us clarify who within our organization to direct your request to.
Building construction type
*
Please Select
Wood frame
Concrete
Concrete & Wood frame mix
Highrise
Outdoor
Other
Please let us know your construction type
Building type
*
Please Select
Single Family Dwelling
Multifamily Dwelling
Commercial/Retail Space
Industrial
Agricultural/Farm
Please let us know the purpose of your building
Scope of Work
*
Please let us know what rough idea of the scope of work?
What Is Your Budget For Your First Work Request?
*
If you have no idea, please list a general number so we can try to work within your budget.
Electrical Service Required
*
Electrical
Lighting
Lighting Controls
Emergency Standby Power
Fire Alarm
Industrial Motors & Motor Controls
Off Grid/Remote Microgrid Solutions
Renewable Power Systems (Solar, Wind, Hydrogen)
Electrical Design
None
Other
Communications Services Required
*
Data Communications (structured cabling)
Audio/Video
Smart Home Controls
Fiber Optics
WiFi Infrastructure
Cellular Infrastructure
Communication Design
Security Cameras
Security Systems
None
Other
Plans, Project & Equipment Specifications, If Available
Browse Files
Drag and drop files here
Choose a file
If files are to large, please attach a FTP folder or cloud file storage link in scope of work above.
Cancel
of
Estimate Due Date
*
-
Month
-
Day
Year
Please Note: Due to the procurement system of our wholesalers, estimates under $10K may take up to 7 business days, $10K and over may take 8 business days, estimates $50K and over may take 10 - 30 business days depending on the scale.
Estimate Due Time
Hour Minutes
AM
PM
AM/PM Option
Estimated Work Start Date
-
Month
-
Day
Year
If ASAP leave blank and note it in scope of work. If it is an unsafe electrical hazard, please call 778-822-7654
Estimated Work End Date
-
Month
-
Day
Year
If unknown leave blank
Payment Method
*
E-transfer (general service projects under $6000) *Preferred
Quickbooks bank-to-bank money transfer(projects over $6000) *Preferred
Cheque
Credit Card (subject to 4% service fee)
Unknown or To Be Decided
Submit
Should be Empty: