Giles Electric Company | Request Service or Bid

Request Service Form | Request Bid Form (Scroll Down)
To request your Service Appointment please complete and submit the form below, and one of our customer service agents will respond within 24 hours.

FOR EMERGENCY'S PLEASE CALL 386.767.5895.

IF YOU ARE IN A HURRY, only the ( * ) FIELDS ARE REQUIRED, you can skip the rest for now.

REQUEST SERVICE FORM		* = required field
* FIRST NAME
* LAST NAME
* EMAIL ADDRESS
CONTACT PERSON (IF OTHER THAN YOURSELF)
HOME PHONE
*BUSINESS PHONE
CELL PHONE
*PREFERRED CONTACT METHOD
ADDRESS 1
ADDRESS 2
*CITY
*ST
ZIP
DESCRIPTION OF PROBLEM/WORK REQUIRED		Please enter description of problem here.
DATE WORK REQ'D
ANY SPECIAL MATERIAL OR EQUIPMENT NEEDED?		YES NO
IF YES PLEASE EXPLAIN		Please enter description of special material or equipment needed here.
ARE YOU FURNISHING MATERIALS?		YES NO
IF YES PLEASE EXPLAIN		Please enter description of supplied materials here.
ADDITIONAL BILLING INFO. (IF REQ'D)		Please enter any additional billing information required here.
METHOD OF PAYMENT (check one)		COD VISA/MC CHECK BILL CUSTOMER CASH
.

REQUEST BID FORM		* = required field
* FIRST NAME
* LAST NAME
COMPANY NAME
* EMAIL ADDRESS
CONTACT PERSON (IF OTHER THAN YOURSELF)
HOME PHONE
*BUSINESS PHONE
CELL PHONE
*PREFERRED CONTACT METHOD
ADDRESS 1
ADDRESS 2
*CITY
*ST
ZIP
JOB NAME
WORK SCOPE		Please enter description of scope of work here.
DATE BID REQ'D
TIME BID REQ'D
BASE BID
ALTERNATES INCLUDED		Please list included alternates here.
ADDENDUMS INCLUDED		Please list included addendums here.
ELECTRICAL SPECIFICATIONS		Please list electrical specifics here.
.


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©2001-11 Giles Electric Company, Inc. #EC0001538. All rights reserved. 1700 S. Segrave Street • South Daytona, FL 32119 \| Ph: 386.767.5895 Click to send email.	Designed & Powered by: Dream Light Digital Report technical difficulties to: Webmaster. Updated: Friday, August 5, 2011 : 6:08 PM