Let Us Repair Your Generators New Client Intake New Client Intake Please complete this form if needing service or preventative maintenance to an already installed generator. If you have any questions, please contact us here. Client Information Name* First NameLast Name Organization/Business Organization/Business Name Date of Birth* -Month -DayYear Phone Number* Please enter a valid phone number. Email* Please enter a valid email address. Address* Street Address Address Line 2 City Please Select 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 Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Back Next Generator Information Generator Description* e.g., serial number, size/capacity, model, etc. Estimated Installation Date -Month -DayYearDate your generator was installed Back Next Add Credit Card to File Credit Card Details* prevnext( X ) Service Fee$1.00 Credit Card First Name Last Name Credit Card Number Security Code Card Expiration Credit Card Authorization* I authorize Beacon Generators, Inc. to charge my credit card above for any services rendered, including but not limited to warranty calls that do not fall under Generac’s warranty guidelines (firmware updates are not covered) or if the technician determines prior installation of the generator is not up to code and is unsafe to conduct service on (for example, the Generator is not installed at least 5 feet away from any structure opening to prevent carbon monoxide poisoning). I understand that my information will be saved on file for future transactions on my account. NOTE: If the credit card on file is processed, there is a 2.8% convenience fee. Please verify that you are human* Submit Should be Empty: