<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%> Dew It All Electric
 
Customer Type:   Existing      New
Billing Information
Company or Individual Name: 
*
Address: 
 *    Apt # : 
City: 
 *   State:  *  Zip:  *
Email: 
 *
  
Person Submitting work order: 
*
Contact Numbers: 
Phone #1: 
 *
Phone #2: 
Cell: 
  
Who should we contact to schedule the work (if different than person above)
Contact Name: 
  
Contact Numbers: 
Phone #1: 
Phone #2: 
Cell: 
 
Where is the work to be done (if different from the above address)   [Same:]
Company or Individual Name: 
 *   
Address: 
 *   Apt # : 
City: 
 *   State:  *  Zip:  *
  
Please give a detail description of the problem and/or work that needs to be done. *
  
Special Instructions: (Is there anything we need to know or do in order to do
this work for you?)
* = Required