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Grid Guard Battery Service Agreement - Monthly
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Rep Name
*
First
Last
Rep Email
*
Does in Email
Dealer Name
Customer Name
*
First
Last
Customer Email
*
Customer Phone Number
*
Customer Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Does the Homeowner live in an HOA?
*
YES
NO
If you selected YES, please fill out HOA Name & Contact number below.
HOA Name
HOA Contact Number
Monthly Plan
*
4 Batteries - $35 / Month
Battery Type
*
EG4
Customer Photo ID
*
Drag & Drop Files,
Choose Files to Upload
You can upload up to 2 files.
Customer Utility Bill
*
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Additional Notes
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