Dish Machine Request Form

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Dish Machine Request Form

Complete the questionnaire below. If approved by the Director of Sales, the normal process will begin for obtaining a dish machine and scheduling the installation

* Indicates required field

Rep Name *

Today's Date *

Customer Name *

Address *

City *

County *

Type Of Establishment *

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

Meals they Serve (Check all that apply) *

Breakfast Lunch Dinner Late Night

Days of Week They Are Open *

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Is there a Banquet Room? *

Yes No

Is There a Second Dining Room *

Yes No

Seasonal Business *

Yes No

If seasonal, provide the number of months open: *

Hours of Operation *

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

Additional Comments *

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

Contact's Name *

Phone Number *

Submit

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