*First & Last Name:

Address of location needing work:

*Address:

*City, State, Zip:

*Type of work needed:

*Email

Type of location:

 Residence   Commercial business   Industrial facility

Questions you have:

Is This an Electrical Emergency?  

 Yes   No 

Best number to reach you:

Day (8am-4pm)

Night (4pm-8pm)

How did you hear about us:

Friend
Referral from another business
Have worked with Indian Creek before
Facebook
Twitter
Website
Other

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