Le Bleu Central 5-Gallon Bottled Water Service Sign-up

Please check our service locations on the homepage map to ensure that we deliver in your area. Le Bleu Central is an independently owned licensee of Le Bleu Corporation and serves many areas in NC and VA.

Upon signing the below agreement, a Customer Service Representative will be in contact to collect payment and schedule your set up. We look forward to servicing you.

Thank you for choosing Le Bleu.

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Do You Need a Cooler Rental? Le Bleu's coolers are commercial grade and repaired or replaced with a cooler rental agreement.*

YesNo, I have my own coolerI am interested in purchasing a cooler from Le Bleu

What kind of cooler are you interested in renting?

Cook and Cold Cooler - $15 per monthHot and Cold Cooler - $18 per monthN/A

What kind of cooler are you interested in purchasing?

Stainless Steel Hot and Cold Cooler - $399.00Hot and Cold Cooler - $350.00Bottom Load Cooler - $399.00N/A

Promo Code:

How many people are in your household?*

1-23-4More than 5

I am interested in*

5-Gallon Bottled Water - $11.99 per bottle3-Gallon Bottled Water - $9.99 per bottle

Our residential deliveries are once a month. How many bottles of water would you like to start with?

I am also interested in the following*

How did you hear about Le Bleu?*

Other

Questions or Comments:

Payments and Terms - Both Parties Agree That:

For the use of each water cooler, Customer agrees to pay rent in the amount of $15, $18 or $59 per month plus applicable taxes.
Equipment shall not be moved from the original address of installation without written consent of Le Bleu Central. Only Le Bleu water is to be used with any & all equipment provided by Le Bleu. All coffee and condiments for the coffee service must be purchased from Le Bleu.
Customer authorizes Le Bleu to enter any premises at all reasonable times where the water cooler, coffee brewer or bottle is located for service work, installation or removal of equipment if necessary. Customer is responsible for unplugging the water cooler or coffee brewer when the reservoir is low to prevent damage to the cooler's condenser. The water cooler, coffee brewer or bottle shall not be deemed affixed or attached to Customer's real estate & shall remain Le Bleu's property.
3-Gallon and 5-Gallon bottles are the sole property of Le Bleu Central. In the event that a 3-Gallon or 5-Gallon bottle is returned in unsatisfactory condition, the Customer will be assessed a $10.00 fee (5-Gallon) or $8.00 fee (3-Gallon) for any bottles returned to Le Bleu in an unsatisfactory condition. If any bottles delivered to the Customer are not returned upon cancellation, a $10.00 fee (5-Gallon) or $8.00 (3-Gallon) per bottle will be assessed.
Customer agrees not to use bottles for any purpose other than storage of Le Bleu Water. Le Bleu will not refund the customer for full bottles of water.
Customer assumes full liability for loss, damage or destruction to any of the equipment, water cooler, coffee brewer or bottle (reasonable wear and tear expected) or any injury to any person or damage to any property caused by or in connection to any of the equipment, water cooler, coffee brewer, bottle or delivery while on the Customer's premises.
Upon termination of this agreement, Customer shall peaceably surrender all equipment and bottles to Le Bleu and is responsible for returning the equipment and bottles to Le Bleu at Customer's expense and in an undamaged condition. Customer agrees to pay Le Bleu if Customer fails to surrender or damages such equipment and product the fair market value (minimum $200, up to $400) of the property as reasonably determined at the sole discretion of Le Bleu who shall have the right to charge the Customer's credit card or account.
Lost or Stolen Equipment: Under this Agreement, Customer agrees to pay Le Bleu for any lost, stolen or damaged equipment for the fair market value as reasonably determined at the sole discretion of Le Bleu who shall have right to charge the Customer's credit card or account.
It is the Customer's responsibility to clean and sanitize water cooler or coffee brewer periodically. Instructions for cleaning and sanitizing water cooler are provided on back of this Agreement.
The Customer agrees to pay Le Bleu the cost of collecting any amount owed or enforcing any right hereunder, including reasonable attorney's fees, court costs, and collection agency fees. Past due accounts will be sent to Collections. Past due accounts are assessed penalty fees which will appear on your monthly statement. By providing a wireless/land line number, you are giving prior express consent to call that number.
This agreement shall become effective upon the date of execution and shall remain in full force and effect until terminated by thirty (30) days advance written notice from one party to the other. Customer authorizes Le Bleu beverage trucks and employees to enter customer property and delivery areas via driveway during reasonable delivery times.

Date*

Date

Upon submission of this form a Le Bleu representative will contact you during normal business hours (M-F, 9-5) to set up payment and schedule your initial delivery at a time that is convenient for you.