Holt Electrical Contractors Gaithersburg, MD 20878 phone: 301-349-2980 1-800-HOLT 4 POWER 1-800-465-8476 fax: 1-301-349-2987 © 2010 Holt Electrical Contractors Inc.

GENERATOR QUESTIONNAIRE First Name: Last Name: E-mail Address: Phone Number: Company Name: Address: What is the best way to reach you? (Please check one.) Phone       Email Is the generator for a home or business? (Please check one.) Home        Business Do you have gas, oil, electric, or propane? (Please check one.) Gas    Oil     Electric     Propane What do you wish to connect to your generator? (Please check all that apply and indicate how many of each item.) Heater Heat pump Air conditioner Lighting Freezer Refrigerator Television Garage door opener Electric water heater Security system Well pump Sump pump Coffee maker Computer Dehumidifier Electric blanket Electric fan Microwave Radio Oven How did you hear about us? Previous customer Referral Saw a Truck Web site Yellow pages Search engine Other information or comments: