HOME SERVICES · CONTACT FORM TEMPLATE

Electrician Service Request Form

Electrician leads break into emergencies (no power, sparking outlet) and projects (EV charger, panel upgrade, recessed lights). One form, one urgency dropdown, two completely different SLAs.

Get free access key Copy the code

1,000/mo free·no card·works on any host

form.htmlhtml43 lines

01<form action="https://splitforms.com/api/submit" method="POST">
02  <input type="hidden" name="access_key" value="YOUR_ACCESS_KEY">
03  <input type="hidden" name="subject" value="New electrical service request">
04 
05  <label for="name">Full name *</label>
06  <input id="name" type="text" name="name" placeholder="Anna Lopez" required>
07  <label for="email">Email *</label>
08  <input id="email" type="email" name="email" placeholder="anna@example.com" required>
09  <label for="phone">Phone *</label>
10  <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required>
11  <label for="address">Service address *</label>
12  <input id="address" type="text" name="address" placeholder="1247 Valencia St" required>
13  <label for="urgency">Urgency *</label>
14  <select id="urgency" name="urgency" required>
15    <option value="">Choose…</option>
16    <option>Emergency — no power / sparking</option>
17    <option>Within 24 hours</option>
18    <option>This week</option>
19    <option>Just a quote</option>
20  </select>
21  <label for="service">Type of work *</label>
22  <select id="service" name="service" required>
23    <option value="">Choose…</option>
24    <option>Panel upgrade</option>
25    <option>Outlet install</option>
26    <option>Lighting / fixture</option>
27    <option>Wiring / rewire</option>
28    <option>EV charger install</option>
29    <option>Generator</option>
30    <option>Other</option>
31  </select>
32  <label for="details">Describe the work *</label>
33  <textarea id="details" name="details" placeholder="How many fixtures, voltage, anything we should know." required></textarea>
34 
35  <!-- honeypot — bots fill every field -->
36  <input type="checkbox" name="botcheck" style="display:none" tabindex="-1" autocomplete="off">
37 
38  <button type="submit">Send</button>
39</form>
40 
41<p style="margin-top:12px;font-size:11px;color:#888;text-align:right">
42  Powered by <a href="https://splitforms.com" style="color:#888;text-decoration:none" target="_blank" rel="noopener">splitforms</a>
43</p>

1,000

submissions / mo, free

fields, ready to ship

code outputs

60s

from copy to inbox

Electrician Service Request Form — example splitforms template with submissions inbox

§ 01Why it mattersthe qualifying-fields argument

Electricians get a wider job-type spread than most trades — same crew might do a $200 outlet swap, a $3,000 panel upgrade, and a $1,500 EV charger install in one week. The form needs a job-type dropdown so the office can quote on the call back, not on-site. EV charger installs in particular have exploded since 2024 — they need the home's panel amperage and whether the customer already has the charger in hand. Two fields, completely different quote.

✦ at a glance

→Electrician service request · 7 fields
→HTML, JS, React, PHP, cURL outputs
→One POST endpoint, no SDK
→Honeypot + classifier, no CAPTCHA

§ 02Live previewinteractive · sandboxed · no key required

See exactly what your visitors see — and you’ll receive.

Left: the rendered form, fully interactive in a sandboxed iframe. Right: the email and dashboard view that lands the moment a visitor submits.

preview · electrician-contact-formlocalhost:3000

✦ what you’ll see in your inbox

Every submission becomes an email plus a dashboard row. The fields below are the exact payload your form will send. Reply-to is wired to the visitor’s email so hitting reply goes back to them.

dashboard · new submission14ms · 200 OK

SUBJECT · New electrical service request

Full name: Maya Iyer
Email: maya@studio71.co
Phone: +1 415 555 0142
Service address: —
Urgency: Emergency — no power / sparking
Type of work: Panel upgrade
Describe the work: Loved your last open house in Hayes — looking for similar with parking. Pre-approved through Wells Fargo.

Iframe is sandboxed — submit doesn’t actually fire. Get your access key to wire it up live.

§ 03Three steps3 steps · ~60 seconds

Generate, embed, receive.

Three actions stand between you and your first lead. None of them require a backend, a database, or a CAPTCHA library.

STEP 01GENERATE

Use the electrician template

Pre-built fields: name, phone, address, job type (panel / outlet / EV charger / lighting / troubleshooting), urgency, description.

Create your form

key=sk_live_••••••••

STEP 02EMBED

Capture EV charger details

If 'EV charger' selected, conditionally show fields for charger model and panel amperage. Saves a 10-minute call. We have a recipe in the docs for the show/hide JS.

snippethtml

<form action="https://splitforms.com/api/submit" method="POST">
  …
</form>

STEP 03RECEIVE

Route to dispatch

Webhook to your dispatch app or to a phone — emergency / no-power leads ping the on-call tech directly via Twilio. Quote leads land in the office inbox for callback.

inbox · 1 newjust now

FROM contact@yoursite.com

New electrical service request

Maya Iyer maya@studio71.co

Loved your last open house in Hayes — looking for similar with parking. Pre-approved through Wells Fargo.

§ 04Copy & ship5 languages · same endpoint

Five outputs. One backend.

HTML by default. Click open the language you ship in — every variant POSTs to the same /api/submit endpoint.

01HTMLform.html43 lines

<form action="https://splitforms.com/api/submit" method="POST">
  <input type="hidden" name="access_key" value="YOUR_ACCESS_KEY">
  <input type="hidden" name="subject" value="New electrical service request">

  <label for="name">Full name *</label>
  <input id="name" type="text" name="name" placeholder="Anna Lopez" required>
  <label for="email">Email *</label>
  <input id="email" type="email" name="email" placeholder="anna@example.com" required>
  <label for="phone">Phone *</label>
  <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required>
  <label for="address">Service address *</label>
  <input id="address" type="text" name="address" placeholder="1247 Valencia St" required>
  <label for="urgency">Urgency *</label>
  <select id="urgency" name="urgency" required>
    <option value="">Choose…</option>
    <option>Emergency — no power / sparking</option>
    <option>Within 24 hours</option>
    <option>This week</option>
    <option>Just a quote</option>
  </select>
  <label for="service">Type of work *</label>
  <select id="service" name="service" required>
    <option value="">Choose…</option>
    <option>Panel upgrade</option>
    <option>Outlet install</option>
    <option>Lighting / fixture</option>
    <option>Wiring / rewire</option>
    <option>EV charger install</option>
    <option>Generator</option>
    <option>Other</option>
  </select>
  <label for="details">Describe the work *</label>
  <textarea id="details" name="details" placeholder="How many fixtures, voltage, anything we should know." required></textarea>

  <!-- honeypot — bots fill every field -->
  <input type="checkbox" name="botcheck" style="display:none" tabindex="-1" autocomplete="off">

  <button type="submit">Send</button>
</form>

<p style="margin-top:12px;font-size:11px;color:#888;text-align:right">
  Powered by <a href="https://splitforms.com" style="color:#888;text-decoration:none" target="_blank" rel="noopener">splitforms</a>
</p>

02JavaScriptform.js59 lines

<form id="lf-form">
  <label for="name">Full name *</label>
  <input id="name" type="text" name="name" placeholder="Anna Lopez" required>
  <label for="email">Email *</label>
  <input id="email" type="email" name="email" placeholder="anna@example.com" required>
  <label for="phone">Phone *</label>
  <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required>
  <label for="address">Service address *</label>
  <input id="address" type="text" name="address" placeholder="1247 Valencia St" required>
  <label for="urgency">Urgency *</label>
  <select id="urgency" name="urgency" required>
    <option value="">Choose…</option>
    <option>Emergency — no power / sparking</option>
    <option>Within 24 hours</option>
    <option>This week</option>
    <option>Just a quote</option>
  </select>
  <label for="service">Type of work *</label>
  <select id="service" name="service" required>
    <option value="">Choose…</option>
    <option>Panel upgrade</option>
    <option>Outlet install</option>
    <option>Lighting / fixture</option>
    <option>Wiring / rewire</option>
    <option>EV charger install</option>
    <option>Generator</option>
    <option>Other</option>
  </select>
  <label for="details">Describe the work *</label>
  <textarea id="details" name="details" placeholder="How many fixtures, voltage, anything we should know." required></textarea>
  <button type="submit">Send</button>
</form>

<p style="margin-top:12px;font-size:11px;color:#888;text-align:right">
  Powered by <a href="https://splitforms.com" style="color:#888;text-decoration:none" target="_blank" rel="noopener">splitforms</a>
</p>

<script>
  document.getElementById('lf-form').addEventListener('submit', async (e) => {
    e.preventDefault();
    const data = new FormData(e.target);
    data.set('access_key', 'YOUR_ACCESS_KEY');
    data.set('subject', 'New electrical service request');

    const res = await fetch('https://splitforms.com/api/submit', {
      method: 'POST',
      body: data,
      headers: { Accept: 'application/json' },
    });

    const json = await res.json();
    if (json.success) {
      e.target.reset();
      alert('Sent!');
    } else {
      alert('Error: ' + (json.message || 'Try again'));
    }
  });
</script>

03React / Next.jsForm.tsx74 lines

'use client';

import { useState, type FormEvent } from 'react';

export default function ElectricianCalloutForm() {
  const [status, setStatus] = useState<'idle' | 'sending' | 'sent' | 'error'>('idle');

  async function onSubmit(e: FormEvent<HTMLFormElement>) {
    e.preventDefault();
    setStatus('sending');

    const data = new FormData(e.currentTarget);
    data.set('access_key', 'YOUR_ACCESS_KEY');
    data.set('subject', 'New electrical service request');

    const res = await fetch('https://splitforms.com/api/submit', {
      method: 'POST',
      body: data,
      headers: { Accept: 'application/json' },
    });

    const json = await res.json();
    setStatus(json.success ? 'sent' : 'error');
    if (json.success) e.currentTarget.reset();
  }

  if (status === 'sent') return <p>Thanks — we&rsquo;ll be in touch.</p>;

  return (
    <>
    <form onSubmit={onSubmit}>
      <label htmlFor="name">Full name *</label>
      <input id="name" type="text" name="name" placeholder="Anna Lopez" required />
      <label htmlFor="email">Email *</label>
      <input id="email" type="email" name="email" placeholder="anna@example.com" required />
      <label htmlFor="phone">Phone *</label>
      <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required />
      <label htmlFor="address">Service address *</label>
      <input id="address" type="text" name="address" placeholder="1247 Valencia St" required />
      <label htmlFor="urgency">Urgency *</label>
      <select id="urgency" name="urgency" required>
        <option value="">Choose…</option>
        <option>Emergency — no power / sparking</option>
        <option>Within 24 hours</option>
        <option>This week</option>
        <option>Just a quote</option>
      </select>
      <label htmlFor="service">Type of work *</label>
      <select id="service" name="service" required>
        <option value="">Choose…</option>
        <option>Panel upgrade</option>
        <option>Outlet install</option>
        <option>Lighting / fixture</option>
        <option>Wiring / rewire</option>
        <option>EV charger install</option>
        <option>Generator</option>
        <option>Other</option>
      </select>
      <label htmlFor="details">Describe the work *</label>
      <textarea id="details" name="details" placeholder="How many fixtures, voltage, anything we should know." required />

      <button type="submit" disabled={status === 'sending'}>
        {status === 'sending' ? 'Sending…' : 'Send'}
      </button>

      {status === 'error' && <p>Something went wrong. Try again.</p>}
    </form>

      <p style={{ marginTop: 12, fontSize: 11, color: '#888', textAlign: 'right' }}>
        Powered by <a href="https://splitforms.com" target="_blank" rel="noopener" style={{ color: '#888', textDecoration: 'none' }}>splitforms</a>
      </p>
    </>
  );
}

04PHPsubmit.php28 lines

<?php
// Drop into a PHP page. Receives a form POST and proxies it to splitforms.com.
// Useful when you want to add server-side validation or rate limiting.

if ($_SERVER['REQUEST_METHOD'] === 'POST') {
    $allowed = ['name', 'email', 'phone', 'address', 'urgency', 'service', 'details'];
    $payload = ['access_key' => 'YOUR_ACCESS_KEY'];
    $payload['subject'] = 'New electrical service request';

    foreach ($allowed as $f) {
        if (isset($_POST[$f])) $payload[$f] = $_POST[$f];
    }

    $ch = curl_init('https://splitforms.com/api/submit');
    curl_setopt($ch, CURLOPT_POST, true);
    curl_setopt($ch, CURLOPT_POSTFIELDS, http_build_query($payload));
    curl_setopt($ch, CURLOPT_RETURNTRANSFER, true);
    curl_setopt($ch, CURLOPT_HTTPHEADER, ['Accept: application/json']);
    $response = curl_exec($ch);
    $status   = curl_getinfo($ch, CURLINFO_HTTP_CODE);
    curl_close($ch);

    header('Content-Type: application/json');
    http_response_code($status);
    echo $response;
    exit;
}
?>

05cURLtest.sh11 lines

curl -X POST https://splitforms.com/api/submit \
  -H "Accept: application/json" \
  -d "access_key=YOUR_ACCESS_KEY" \
  -d "subject=New electrical service request" \
  -d "name=Jane Builder" \
  -d "email=jane@example.com" \
  -d "phone=+15555555555" \
  -d "address=Jane Builder" \
  -d "urgency=Emergency — no power / sparking" \
  -d "service=Panel upgrade" \
  -d "details=Hello from cURL"

Replace YOUR_ACCESS_KEY with the key from your dashboard. That’s the only edit.

§ 04bUse this template with…17 frameworks · same backend

One template. Every framework.

The same field set works on every framework splitforms supports. HTML, React, Next.js, Vue, Astro, Hugo, WordPress — same POST, same backend.

§ 06FAQ4 answered

Things people ask before they ship.

Direct answers, no marketing fluff. Missing one? Email hello@splitforms.com.

01Do I need separate forms for residential vs commercial?

Most one-truck shops can use one form with a 'residential / commercial' radio. If you have separate intake processes (commercial often involves bid documents and net-30 invoicing), split into two pages — both can use the splitforms backend.

02Can the form trigger a same-day callback?

Yes — webhook to Twilio or CallRail. Submissions with urgency='emergency' fire an outbound call notification to the on-call tech's phone within seconds. We've seen shops get callback time under 90 seconds this way.

03Is there a way to attach a photo of the panel?

Use the file-upload variant — Pro feature. The customer can snap their breaker box and attach. Saves a truck roll for diagnostic-only callouts.

04What about lead quality from Google LSAs vs my own form?

LSAs are great until the cost-per-lead climbs to $50+. A direct form on your own service-page (paired with local SEO) costs you nothing per lead and the customer's intent is higher — they searched, clicked, and read your page before filling out the form.

✻ ✻ ✻

Ship your electrician service request form in 60 seconds.

1,000 free submissions per month. No credit card. Copy the snippet, paste your access key, watch leads land in your inbox.

Get free access key →Browse all 60 templates →

v0.1 · founders pricing locked in · early access open