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Customer Information
*First Name
*Company Name
Address
City, State, Zip
*Phone
Fax
Email
Generator Site
*Name
Phone
Application Info
Check One:
Generator Load Bank
Date Needed:
Amps:
Phases:
Number of Leads:
Prime Standby
Unit Size:
(kW) (kVA)
# of Estimated Run Hours Per Day:
Length of Rental (Days/Weeks/Months):
Accessories
Check All That Apply:
Cables Qty
Cable Length (Per Lead)
Pigtails Qty
Power Distribution Box Qty
Delivery
OUT
CPS&S Delivery Customer Pick-Up
IN
CPS&S Pick-Up Customer Drop-Off
Payment Method
Cash Credit Card (*Visa, MC, Am. Express, Discover) Check (*subject to approval) Charge to CPSS Account # (Subject to Approval - Up to 3 Days)
*REQUIRED FIELDS
