Pro Install Application

First Name*

Last Name*

Phone*

Email*

Website

street address*

Address line 2

city*

state*

zip/postal code*

COMPANY INFORMATION

Annual Gross Revenue*

Liability insurance coverage*

Service geographic area*

# of years in business*

# of install crews*

# of licensed electriciance*

PRODUCTS YOUR COMPANY CURRENTLY SELLS *

STATES YOU CURRENTLY HOLD LICENSES AND WHAT TYPES *

DESCRIBE THE PERCENTAGE MAKEUP OF YOUR WORK TYPES * Ex. Industrial 25%, Service 30%, Commercial 30%, Residential 15%

AREAS OF EXPERTISE * Lighting/Electrical Installation (all inquiring contractors MUST have licensed electricians on staff)
General Contractors (concrete, sheetrock)
HVAC Contractor

TELL US WHY CLEAN POWER BOX SHOULD CONSIDER YOU AS AN INSTALLATION CREW: *

Pro Install Application

COMPANY INFORMATION

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