Section 1: Customer Information
Name:
Address:
City:
State/Province:
Country:
Zip/Postal Code:
Phone Number:
Fax Number:
Email:
Section 2: Application Specifics
Type:	Off grid (no utility power) Grid tie (utility power) Back up power (for emergencies)
Site Location:
Southern exposure:	Yes No
Type of usage:	Summer only Weekend Permanent residence Other
Primary interest:	Solar Wind Micro-Hydro Hybrid
Type of inverter:	Modified Sine Wave True Sine Wave
Type of module mount preferred:	Roof Ground Pole
Solar Array's distance from battery bank:
CSA required:	Yes No
Current system details:
Section 3: Expected Load
Choose all that apply:	VCR Lights TV Furnace Dryer Computer	Vacuum Toaster Microwave Hot water tank Typical demand loads Other
Section 4: Implementation
Expected installation date:
Potential Budget:
Install required:	Yes No
Disclaimer: All information collected is for internal use only and will be kept strictly confidential. No information will be sold/given to 3rd parties for any marketing purposes.
For Office Use Only:
File/ P.O #
Sales Representative:
Dealer #