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Your full name
Numbers

When you supply telephone and fax numbers, I ask for the range of hours between which it is appropriate to call you at each number. Please take into consideration both weekdays and weekends.

Day--
Call the following phone number between not earlier than when in the a.m. and not later than when in the p.m.? (Please fill in something. If calling any time is okay, say "24 hours.")

Day Phone number:

Evening/Weekend Call the following phone between how early in the a.m. and how late in the p.m.? (Please fill in something. If calling any time is okay, say "24 hours.")
Phone number:

Fax number, if fax you've got:

Email address, if you regularly check email:

Second adult's full name, or Organization name, if applicable:

Second adult's phone--
Phone number:
Call this phone between how early in the a.m. and how late in the p.m.? (Please fill in something. If calling any time is okay, say "24 hours.")

Job Address, including zip code:

Your own Address, including zip code, if different from the job address:

So . . what sort of job or jobs you want me to come over and do? I'll make additional notes based on talking with you, and what I find in place at your location of course may make a difference. Still, this is the place to put down whether what you have in mind is for me to troubleshoot a non-working light, upgrade the electrical service to a corner grocery, or plan out a sweat-equity house rewiring.

Appointment Nature:

After reviewing my Terms of Engagement, feel free to also mention any preferences you have regarding appointment times--for instance, if it's worth paying the premium to have me come out during the evening, or if you happen to be off work every other Monday.

Appointment Preferences:

I'd like to know how you came to find me. If friends referred you, I'd appreciate their name. If it was a paper, I'd like to know which one. If you found me through a web search, or by tracking me down after reading one of my books, articles, or interviews, I'd like to know that.

Referral source: An article I wrote, which was printed in . . .(please specify in next field, as best you can) One of my books, . . . (please specify in next field, as best you can) A lecture or seminar I gave to . . . (please specify in next field, as best you can) An interview or article that quoted me, which you came across in . . . (please specify in next field, as best you can) An old ad in the Takoma Voice An old ad in the Washington City Paper An old ad in the Cap-M Yellow Pages Web search Personal recommendation by (please put name in next field). . . Other (please specify in next field): . . .
Detail:

If I may need to do repairs in your electrical panel, or if you want me to run a new circuit, it will be helpful to know what you've got. Look and tell me, if you can, whether you have fuses or circuit breakers. If you have circuit breakers, look for the brand name on the cover of the panel (sometimes on the inside of a door) and, if you can find it, tell me what it says. (Looking at the circuit breakers themselves, rather than the panel instructions, can mislead. There are many "interchangeable" breakers that really have no business being installed in some of the panels they happen to fit.)

If you ask me to run new wiring for you (yes, even just adding one receptacle or light at a new location), the law says that I need to apply for a permit, so my work can be inspected when complete. If this is the case, before I perform the work you will need to dig up some information commonly found on a mortgate or lease.
RENTERS: First, whatever the jurisdiction, if you are not the owner of the building, they will want to know the owner's name, address, and phone number.

Owner Information:

The other information required varies from jurisdiction to jurisdiction, but if you can locate all the following bits (commonly found in mortgage papers), we're covered.

Lot:

Block:

Subdivision:

Nearest cross street:

That's the information I'd like you to send, to ssave us both time.