Business Name
Contact Name
Business Address
Contact
Phone Number
Fax Number
E-mail Address
Estimated square
footage of Business
Primary form of lighting
Fluorescent Lights
Standard Incandescent Lights
HID
Any Current of Past Electrical Problems?  If yes Please List
Are you interested in an estimate for
an Energy Efficiency Change Over?
Yes
 No
Do you currently have lighting in
a Storage area or Warehouse?
No
Yes
Phone
What is the best Way to contact you?
E-Mail
Never have enough time to change that one bulb out in the loading dock?  That
one pesky outlet not working so you just keep using another one?  Not sure why
the same breaker keeps popping day in and day out?

Let Breaker Electric Inc. handle those problems for you by signing up for a
Service Maintenance Plan.

Service Maintenance Plans are created customary to the needs of each
business.  Plans may consist of but are not limited to.... Monthly walk through to
check for bulb outages and address any electrical issues noted by staff,  
immediate service for any electrical problems called in, free estimates and
discounted prices on labor.  

Starting price for Maintenance plans is $57 per month.

Fill out the short questionnaire below and a representative from Breaker Electric
Inc. will contact you for an appointment to do a walk through of your business.
SERVICE  MAINTENANCE
PROGRAM QUESTIONNAIRE