Store ID Salesperson

First Name Last Name Company Name Address City Province Postal Code Phone Number Email Address

First Name Last Name Company Name Address City Province Postal Code Phone Number Email Address

Building Type Food Retail Hospital Refrigeration Nursing Homes University/Colleges Warehouse Wholesale Schools Large Hotel (Corridor/Lobby) Large Office Large Non-Food Retail Other Non-Food Retail Other Commercial Buildings Restaurant

I confirm that the installation site is Retrofit lighting and is not being used in a new construction project.