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2019-05-21T00:19:57-05:00
Name
*
First
Last
Company Name
Job Title
Phone
Email
*
Organization Type
*
-- Please Select --
Commercial/Industrial/Multi-Family
Retail & Hospitality
Municipal & Government
Schools & Universities
Hospitals & Medical Facilities
National Accounts
Energy Service Company (ESCO)
Contractors
Lighting Supplier or Manufacturers
Address
City
State / Province / Region
Project Start Date
-- Please Select --
Within the next 1 - 3 months
Within the next 4 - 6 months
Within the next 7 - 12 months
Within the next 12+ months
What is your current Electric Rate (Kwh Rate)?
How do you currently maintain your lighting?
-- Please Select --
Self Maintain
Service Provider/Contractor
Will you require installation?
-- Please Select --
Yes
No
Not Sure
Any Experience with LED Lighting, Good or Bad?
Message
Funding and Financing Consideration
-- Please Select --
Yes
No
Existing Fixture Type
Existing Lamp Wattage
Existing Fixture Wattage
Fixture Quantity
Upload Photo of Existing Lighting Application
Accepted file types: jpg, gif, png.
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