DoctorLED Quote Form

1
Name* This field is required.Please Enter First and Last Name Below
First Name
Last Name
2
Contact Information* This field is required.Please enter your Phone Number and Instagram below!
Phone Number
Instagram Username
TikTok Username
Call/Text
Instagram Direct Messages
TikTok Direct Messages
How would you like to be contacted?
3
Vehicle Information* This field is required.Please enter all vehicle information below!
Year (Ex. 1999)
Make (Ex. Honda)
Model (Ex. Civic)
Trim (Ex. LX)
Please Select
Please Select
No
Yes - Regular Sunroof (Stops just behind head)
Yes - Moonroof (Stops just behind back seat)
Yes - Dual Sunroof (multiple sunroofs)
Yes - Panoramic Sunroof (80% of headliner is glass)
Does the vehicle have a sunroof?
4
Service* This field is required.Please select below what service you are interested in! YOU CAN SELECT MULTIPLE SERVICES!!
Please Select
Starlight Headliner
Ambient Trim Lighting
Headlight Modifications
Vehicle Underglow
Other
What service are you interested in?
5
Starlight Headliner* This field is required.Since you’ve Selected “Starlight Headliner” please take a moment a read questions below THOROUGHLY and answer all questions! IF YOU ARE UNSURE OF SOMETHING PLEASE STOP AND CONTACT US! Minimum Star Amount Coupes: 300 | Sedans: 450 | SUVs: 600 ANY STAR AMOUNT OVER 700 PLEASE SELECT DUAL TWINKLE OPTION!!! Twinkle Options (ALL OPTIONS COME RGB) No-Twinkle (Stars will have no twinkle effect) Single Twinkle (Stars will have twinkle effect) Dual-Twinkle (2-faced twinkle effect look - MINIMUM 700 STARS) Shooting Stars Options : White-Only (Will only be the color white) RGB (Will have the option to change color!) Custom Design : If you would like a custom design please have whatever design you would like ready when contacted!
Desired Star Amount
Please Select
Please Select
No Twinkle
Single Twinkle
Dual Twinkle
Twinkle Option
Please Select
Please Select
Yes, White Only!
Yes, RGB!
No, just my regular non-twinke OR twinkle stars.
Shooting Stars?
Please Select
Please Select
YES, please contact me regarding design!
NO
Would you like a custom design? (Name, Logo, etc..)
6
Ambient Trim Lighting* This field is required.Since you’ve Selected “Ambient Trim Lighting” please select an option below! Our “Full Interior Package” includes ambient lighting on The Dash, The Doors, and in the Footwells!
Please Select
Please Select
Dash Only
Doors Only
Footwell Only
Dash and Doors Only
Full Interior Package!
Which option are you looking for?
7
Headlight Modifications* This field is required.Since you’ve Selected “Headlight Modifications” DoctorLED will contact you personally to discuss options! Do you understand?
YESNO
8
Vehicle Underglow* This field is required.Since you’ve Selected “Vehicle Underglow” please take a moment a read questions below THOROUGHLY and answer all questions! IF YOU ARE UNSURE OF SOMETHING PLEASE STOP AND CONTACT US!
Please Select
Please Select
RGB (Any Color)
RGBW (Any Color + PURE WHITE)
Flow Series (RGBW + Color-chasing Patterns)
Ghozt (Syncs with your headlights & Turn Signals)
What kind of Underglow would you like?
Please Select
Please Select
4-Strip Kit
6-Strip Kit
How many strips would you like?
Please Select
Please Select
Yes!
No.
Would you like to add “DRL and Turn Signal Functionality”? [ONLY APPLIES TO RGB, RGBW, and FLOW SERIES]
9
Other : Service* This field is required.Please type below what service you are interested in!
Example : Dash Cam Installation
10
Date* This field is required.Based off the availability calendar that is posted on DoctorLED Instagram Story, what day would you like to come in? If you do not see a “CURRENT AVAILABILITY” calendar posted on our Instagram story and would like to see available days please contact us! If you are not worried about a day yet simply select today’s date!
Date
Year
Month
Day
11
Service Speed* This field is required.Did you want to add sameday service to your quote?
YESNO
12
Mobile Service* This field is required.Did you want to add mobile service to your quote?
YESNO
13
Mobile Service* This field is required.If you selected “YES” for mobile service please enter address below! If you selected “NO” for mobile service please enter “DoctorLED772” and select our business location! Mobile Fee Rates : Within 60 Minutes of DoctorLED : $120 60- 120 Minutes from DoctorLED : $200 120-150 Minutes from DoctorLED: $250 150+ Minutes from DoctorLED : TBD
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
14
Please verify that you are human* This field is required.
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