Wallace Electric, Inc.
Service Request Form
Please Enter All Fields.
Your Name:
Phone #:
Store #:
Store Address:
City:
Person Authorizing Electrical Work:
(i.e. Manager's Name or Owner's Name)
Type of electrical service requested...
Please be detailed:
Is this an emergency request?:
No
Yes
When do you need the work done by?
Please Type This Verification Code:
udyzdr
(Code is case sensitive.)