Edwards Electric New Customer Intake Form

New Customer Intake Form

Hello, welcome to Edwards Electric. 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?*
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 NameLast Name
Phone Number*
Key Contacts Direct Line
Email*
example@example.com
Customer Type*

PersonBusiness
Business Name, if applicable
Business Phone Number, if applicable
Please enter valid business phone number.
Site Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Billing Address (if different from site)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Site Coordination Contact Name, if applicable

First NameLast 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 NameLast Name
Accounts Billable Contact Email, if applicable
example@example.com