Zap Cap Order Form

Installation Information

Do you have your Tampa Electric account number available?: Yes No

Tampa Electric account number:

Street number:

Street direction:

Street name (Main, Oak, etc):

Street suffix:

Apartment or lot number:

City / State / Zip:

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Please enter your State.

Please enter your ZipCode.

Total square footage of house: Less than 2,500 sq. feet Greater than or equal to 2,500 sq. feet Don't know

Is your electric meter accessible to our installers? Yes, electric meter is accessible No, electric meter is not accessible Don't know

No appointment is necessary for installation, but if you would like an appointment, please type "yes" in this box.:

Customer Information

First name:

Last name:

E-mail address:

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Phone Number:

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Order Information

Zap Cap System^® Basic Package	Price
Installation Charge Includes meter-based primary unit. In addition, select either the multimedia home office plug-in protector at no additional charge, or upgrade to the deluxe home entertainment plug-in protector for $30.00 (provided at time of installation).	$44.95
Monthly Service Fee	$7.95

Choose ONE of the following plug-in protectors

Multimedia home office plug-in protector To help protect your computer, printer, fax and router, choose the multimedia home office plug-in with 8 outlets spaced to accommodate small power supplies.	Free
Or, choose the deluxe home entertainment plug-in protector Protecting your TV, DVD or Blu-ray players, stereo equipment and gaming systems is easy with the deluxe home entertainment plug-in. With 8 wide-spaced outlets, extra cable connectors and a 3-foot coaxial cable, you'll have everything you need. (Regularly priced at $79.95 if purchased separately)	Special offer! $30 with first installation!

Optional Products

Now that you have selected one of the above plug-in protectors with the basic Zap Cap Systems package, please consider optional Zap Cap products below to protect additional sensitive electronics in your home.

Remember: All electronic equipment must be plugged into a Zap Cap Systems^® plug-in protector to qualify for the manufacturer's warranty coverage.

Optional Zap Cap Products	Unit Price	Price
Single-outlet plug-in protector	$11.95	$0.00
Multimedia home office plug-in protector	$49.95	$0.00
Deluxe home entertainment plug-in protector	$79.95	$0.00
*Subtotal:		$0.00
*plus applicable sales tax

*The subtotal includes the $7.95 monthly maintenance fee, and the one-time cost of any extra items you purchased, plus applicable sales tax.

Your Zap Cap Systems^® fee and applicable sales tax will be conveniently added to your electric bill.

By submitting this order, you are giving consent to our approved contractor, Terry's Electric, to install a Zap Cap System on the exterior of your residence.

Terry's Electric will contact you by telephone before arrival at your home
The contractor will call you after completing the work
An appointment is not required. If one is preferred, please note this in the comments section of the order form.
Please read the confirmation email for more details regarding the installation process

If you have questions or to learn more about package pricing, please call 877 SURGE 22 (877-787-4322).

IMPORTANT NOTICE ABOUT YOUR REQUEST: If you do not receive a confirmation e-mail after you have submitted this form, you may have provided an incorrect e-mail address or your spam filter, a system for blocking unwanted e-mail messages, may be switched on.

Limited Time Offer!

Installation Information

Customer Information

Order Information

Optional Products