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                                                                            Light Poles  -  Form

Date                                             

Name Company     

Phone Office Cell Fax


Location  Address

Email

City 
   State   Zip


Contractor / General  Infomation

Contact  Name     Company     

Phone Office Cell Fax

Email


Location  Address

City     State   Zip



Light Poles how many  

Street Light Poles    Height     Diameter      Total  FT

Access   Easy     Hard     


Intersection Light Poles    How Many  poles     Intersections  

 Height     Diameter        Total  FT
                                                                                                                                  
Access   Easy     Hard     



Sand Blast  -  Normal    White metal    Grind and scrap
only     Sand Cost     Water Blast

Get Sand - Pots - Hoods  where

Contact  Name     Company     

Phone Office Cell Fax


Location  Address

City     State   Zip



Type of Paint
      Primer     Cost per Gal.   Paint - Ft per Gal  
      Finish      Cost per Gal.   Paint - Ft per Gal  

                     Not Sure of kind of paint to use  
Paint Company and Rep Infomation


Contact  Name     Company     

Phone Office Cell Fax


Location  Address

City     State   Zip



Lifts  1     2     3  

Contact  Name     Company     

Phone Office Cell Fax


Location  Address

City     State   Zip



 Lift Price Per Day    Per Week  Per Month  


• Boom Lifts - Articulating    • Boom Lifts - Telescopic    • Bucket Trucks 
• Personnel Lifts   • Scissor Lifts - Rough Terrain    • Scissor Lifts - Slab 



Traffic Control   

Contact  Name     Company     

Phone Office Cell Fax


Location  Address

City     State   Zip  

Approximant Cost


Lead Abetment Removal   Yes    No    Amount  

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