Dish Machine Request Form

Type Of Establishment *

Average Nightly Covers (number of eating customers/night) *

Manufacturer/Model of Dish Machine *

Is the Dish Machine New or Reconditioned? *

New Reconditioned

Lease Type *

Other - "Lease Types" *

Lease or Sale Price *

Is there a water softener at this location? *

Yes No

Provide the results of the water hardness drop test: *

Additional Ancillary Products *

3-Sink Housekeeping Paper Handsoap

To assist the Service Technicians, please provide and name and phone number for an on-site contact for the survey