Hurricane Survey - Electrical
Department of Licensing and Consumer Affairs Electrical Supply Price Survey Form Name of your Business: ______________________________________ Your Business Physical Address: ______________________________________ Telephone Number:____________________ Business Number: ___________________ Social Security No:_____________________ Tax I.D. No.: _______________________ Legal form of Business: □ Corporation □ Partnership □ Partnership □ Joint Venture □ Individual ITEM UNIT LOW HIGH R/R Electrical Outlets Each $___________ $___________ R/R Service Entry Each $___________ $___________ R/R Smk., Alrm., Hrd., Wrd Each $___________ $___________ R/R Electrical Fixtures Each $___________ $___________ R/R Ceiling Fans Each $___________ $___________ R/R Garage Door Openers Each $___________ $___________ Electrical Inspection and Estimate Job $___________ $___________ Total Electrical System Replacement ITEM LOW HIGH R/R Economy $_____________ $____________ R/R Average Quality $_____________ $____________ R/R Good Quality $_____________ $____________ R/R High Quality $_____________ $____________ Ov …
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Department of Licensing and Consumer Affairs Electrical Supply Price Survey Form Name of your Business: ______________________________________ Your Business Physical Address: ______________________________________ Telephone Number:____________________ Business Number: ___________________ Social Security No:_____________________ Tax I.D. No.: _______________________ Legal form of Business: □ Corporation □ Partnership □ Partnership □ Joint Venture □ Individual ITEM UNIT LOW HIGH R/R Electrical Outlets Each $___________ $___________ R/R Service Entry Each $___________ $___________ R/R Smk., Alrm., Hrd., Wrd Each $___________ $___________ R/R Electrical Fixtures Each $___________ $___________ R/R Ceiling Fans Each $___________ $___________ R/R Garage Door Openers Each $___________ $___________ Electrical Inspection and Estimate Job $___________ $___________ Total Electrical System Replacement ITEM LOW HIGH R/R Economy $_____________ $____________ R/R Average Quality $_____________ $____________ R/R Good Quality $_____________ $____________ R/R High Quality $_____________ $____________ Over head* Include Insurance & Tax $_____________ $____________ Profits* $_____________ $____________ *Provide these figures only if they are not included in the unit cost. I hereby certify that the information provided herein is true and correct. _____________________________ _________________________ ________________ Print Name Signature Date