In order for us to provide the highest level of electrical service, please fill out the form below. A member of our staff will contact you to schedule your appointment after we receive your information.

At Home Touch Electric your privacy is of utmost importance to us! We will never provide or sell your personal information to any third party.

Please Note: Items with an * are required.

* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* Zip Code:
* Day Phone:
* Evening Phone:
* Email Address:
Are You a Club Member? Yes No
Preferred Contact:
* Preferred Date:
* Preferred Time:
ex. 01:30 PM or (between 1:00 and 2:00 pm)
* Alternate Date:
* Alternate Time:
ex. 01:30 PM or (between 1:00 and 2:00 pm)
* Reason For Appointment: