Date:

Area Identification:

Company Name:

Contact Name:

Title:

Address:

City:

State:

Zip:

Phone:

Fax:

Email:

EXISTING CONDITIONS:

Fixture Type:

(fluorescent, high bay, low bay, etc.)

Fixture Quantity:

Lamp Type:

(HPS, MH, PS/MH)

Wattage:

Light Level:

Hours of Operation:

KWH Rate:

PROPOSED DESIGN:

Fixture Catalog #:

Fixture Quantity:

Fixture Type & Model:

Wattage:

Light Levels:

Desired End User Fixture Price:

(not distributor price)

CONTROLS (check all that apply):

Occupancy Sensors

Timers

Automated Building System

Low Mode % of Operation

Dimmers

Daylight Sensors

Manual Switching

Give a brief description of control operation:

OTHER:

Desired ROI:

(return on investment)

Utility Rebates:

Estimated Installation Costs per Fixture:

Give a brief description of project overview and desired objective: