DEALER’S ORDER FORM FOR DBK's GRID-TIE SYSTEMS

Date of Order:

 Dealer’s Name:  

Address:

 City:  State:    Zip Code

 Customer’s Name:

  Telephone Number:

Dealer's Purchase Order Number

System Requested Grid-Tie

Grid Tied System (Includes Panel (s), Grid-Tied Inverter(s) and Connection Parts):

 Quantity:        Unit Number (s):    Custom Project Check Box

Type of Panel:         JIL-3000           JIL-15000

                        Quantity:                Quantity:             

Auto Transfer Switch:  Yes     Number of Switches:

Hardware:   Yes         

Racking: Yes        If racking is needed specify type of roof:

Battery Regulator: Yes     Number of Regulators:

Battery Bank & Recharger system:   Yes      

Shipping and Handling: Pick up at DBK, or Crating Charge May Apply        

Completing the Job/Project

Electrician’s Name:  

License Number: