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Start Up Field Service Request Form

Please complete this form to request field services for Signify Lighting Systems products.
Signify Lighting Systems field services services are scheduled on a first come, first served basis. Three to four weeks notice is advised for booking services. Requests made within within three weeks will incur a min of $1,000 expedite fee pending work load/site requirements. Typical cycle time to confirm a Field Service Appointment is 2-3 business days from receipt of a valid service request. If you don't have a valid PO and you require services, please contact

* denotes required fields
*Project Name:
*Site Address:
Province (International):
Postal Code:
*Service Type:
*Partial or Complete Job?
*Signify Product Type:
Signify Sales Order Number:
* Signify Purchase Order Number:
*Preferred Start Date for Service:
*Alternate Start Date for Service:
*Requested Turnover Date:

Notes: (Include Special Requests)

Requestor Information
*Requestor Name:
Jobsite Contact Information
Check here if same as requestor information
*Contact Name:
*Is a site safety course required?
If yes, list safety course time and location:
*Is specialized Personal Protective Equipment (PPE) required (other than safety toe shoes, glasses, hard hat, and reflective vest)?
If yes, please list additional Personal Protective Equipment (PPE) required.
*What are typical working hours for this jobsite?
Is work permitted beyond typical working hours?
By submitting this request for field service, Requestor attests that all information provided in this form is correct. If delays/obstructions prevent completion of services, additional fees may apply and a change order will be required to resume work.
*Please Initial Here
Signify Field Service Representative Scope of Work:
Field Service Representative will perform services as listed in referenced sales documents and associated quotations.
Field Service Representative will NOT be able to:
Install equipment or make electrical connections required of the installing contractor, including Power, Class 1 and Class 2 Control wiring, and/or any other connections that require a licensed electrician.

I understand the scope of work for the Signify Field Service Representative
*Please Initial Here

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