LightBoss® Facility Self Survey Form

Since your HID lighting system is application driven, so is our LightBoss® system. If you would take the time
to provide us with the following information/data on your facility, we’ll be able to provide you with a basic proposal
to fit your needs.

As a suggestion, we recommend that you:
(1) Print this form.
(2) Survey your facility & fill out the printed form (use a separate form for each application area).
(3) Enter the surveyed information/data into the form on your computer.
(4) Then send it to us by clicking on the Submit button at the bottom of the form.

If you have any questions and/or need our assistance, call Sandy Edwards at 908-788-0729
Related documents such as pictures or actual amp/circuit readings can be emailed to perfectanswer@patmedia.net


Contact Information ( * indicates required fields)

*Company Name:: *Contact:
Address: Title:
City: Phone:
State: Fax:
Zip Code: *E-mail:

Lighting Information

Application:
(describe HID lighting)

Hours of Operation: Days per Week:
KWH Rate: Lamp Count:
Lamp Wattage: Voltage to Lamp:
Lamp Type: Hi-Press Sodium Mercury Vapor
Do lamps use a
common neutral? 		No Energy Provider :

Panel Information

Panel#/Location: (check one): 3 phase
Panel Voltage: (check one): 3 Wire 4 Wire
Lamp Wattage: If 3 Phase(check one) : Wye Delta
Total # of circuits : Total # of lighting circuits:
Circuit size (amps): Breakers: 1 Pole 2 Pole 3 Pole


Lighting controls currently in use:
Lighting controls planned:
         
Please contact me by:
Email Phone    


Comments,
Questions,
Notes

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