12623-ks-Clone of FRANCHISE SUPPORT REQUEST FORM

Franchise Support Request
Requestor / Franchisee Name*

First NameLast Name
What Is Your POOP 911 Company Email Address?*
example@example.com
What is your Support Request Related To?*
Default
What Needs To Be Done?
Billing Support Request
What Needs To Be Done?
Technician Support Request
What Needs To Be Done?
Customer Support Request
What Needs To Be Done?
Marketing Support Request
What Needs To Be Done?
Territory Support Request
Please Follow These Instructions to Complete Your Request
Please Follow These Instructions to Complete Your Request
Please Follow These Instructions to Complete Your Request
Please Follow These Instructions to Complete Your Request
Please Follow These Instructions to Complete Your Request
Please Follow These Instructions to Complete Your Request
Please Follow These Instructions to Complete Your Request
Please Follow These Instructions to Complete Your Request
Please Follow These Instructions to Complete Your Request
Please Follow These Instructions to Complete Your Request
Please Follow These Instructions to Complete Your Request
What is the technology issue or suggestion for improvement related to?

Issues with Tech's ScheduleBARCS - ChromeBARCS - Firefox / MozillaBARCS - Internet ExplorerBARCS - Safari (iOS, Mac, PC)EmailFranchise Resource CenterPhone System - Misrouting of Customer CallsMobile Device (iPhone, Android, etc.)SignUp Form - Account CreationSignUp Form - Account DeactivationSignUp Form - Text/Email NotificationsFSR Form SuggestionsOther
Does this involve an Existing Report or is this a New Report Request?

Existing ReportNew Report
Report Name
Please Provide Additional Details for Your Reporting Request?
Customer Name*

First NameLast Name
Customer Location # in BARCS
New Address Service Will Be Provided At

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date When Service Needs to Be Transferred

MonthDayYear
Old Account #
New Account #
Date of Service Order

MonthDayYear
Reason for the Customer Refund?

DissatisfiedDid Not Receive ServiceBad WeatherOther
Reason for the Adjustment?

DissatisfiedDid Not Receive ServiceBad WeatherOther
Customer Date(s) to Apply Refund
Customer TOTAL Refund Amount
Amount Needing to Be Adjusted
Invoice # to Be Voided
Invoice Date

MonthDayYear
Amount on Invoice
New Invoice # Replacing Voided Invoice
Reason for the Void?

DissatisfiedDid Not Receive ServiceBad WeatherOther
Amount That Needs to Be Applied From Open Credit
Reason?

DissatisfiedDid Not Receive ServiceBad WeatherOther
Upload an Excel File if Multiple Customers Need to Be Written Off

Browse Files

Cancelof
Current Frequency of Service and/or Number of Dogs
Invoice #
Invoice Date

MonthDayYear
Amount of Invoice
Upload Check Info Picture

Browse Files

Cancelof
New Frequency of Service and/or Number of Dogs
Current Service Schedule
New Service Schedule
When Does The Customer Need to Show On The Tech's Schedules?

MonthDayYear
When do the Changes Need to be Applied?

MonthDayYear
When Does Service Schedule Need to be Changed by?

MonthDayYear
Date the Customer Needs to Have Service Canceled

MonthDayYear
When do Changes Need to Be Applied By?

MonthDayYear
Reason Why Service Needs to be Cancelled
Are All Generated Service Orders Needing to be Canceled?

YesNo
Billing Schedule Requested
Amount Needing to be Processed
Date of Invoices the Amount Needs to Be Processed Against

MonthDayYear
Account Number
Are We Adding a Credit Card or an ACH?

Credit CardACH
Card Number
Expiration Date
CVV Code
Routing Number
Tech Name

First NameLast Name
Tech Email
example@example.com
Tech Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Tech Phone Number

Area CodePhone Number
Tech Start Date

MonthDayYear
Branches Tech Should Be Assigned To
Commission Rate %
Flat Rate to Pay Technician Per FREE 1$ Cleanup Service -- Note -- This will be calculated automatically in the PAYOUT - Scooper Commission report in BARCS if populated.
(Suggest default value of $20 but you may enter desired value)
Date Tech Schedule Was Not Received?

MonthDayYear
Did The Tech Receive Daily, Weekly, or Neither?

DailyWeeklyNeither
Did You Tech Receive Daily, Weekly, or Neither?

DailyWeeklyNeither
Upload of Tech's Schedule

Browse Files

Cancelof
When Does the Tech Need to Change By?

MonthDayYear
Are We Moving Customers From a Current Tech to This Tech?

YesNo
Are We Moving Customers From This Tech to a New Tech?

YesNo
Does the Tech Providing Service Need to Change?

YesNo
Old Tech Name

First NameLast Name
New Tech Name

First NameLast Name
What Additional Changes Need to be Made on the Customer Account?
What Was the Issue You Were Experiencing When Updating the Frequency of Service and/or Number of Dogs?
Which Orders Need to be Cancelled?
Old Service Instructions
New Service Instructions
What Was the Issue You Were Experiencing When Updating the Service Instructions?
Issue You Are Experiencing When Trying to Update the Customer's ACH?
Issue You Are Experiencing When Trying to Update the Customer's Credit Card Info?
What Issue is Your Customer Having With Using the Customer Portal?
By When Do These Changes Need to Be Applied?

MonthDayYear
Please Provide Additional Details for the Issue You're Seeing
Price Updates*
Zip Code Updates*
New Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
New Phone Number

Area CodePhone Number
Business Name on Check/Account Info
Upload Screenshots of Caller History

Browse Files

Cancelof
Upload Voicemails

Browse Files

Cancelof
Upload Void Check Picture

Browse Files

Cancelof
Upload Excel with New Pricing

Browse Files

Cancelof
Upload Excel with Zip Code Updates

Browse Files

Cancelof
Upload any Files/Documents

Browse Files

Cancelof
Please Upload Screenshots of the Affected Account(s)

Browse Files

Cancelof
Please Upload Any Mock-Ups / Related Files

Browse Files

Cancelof
What Do You Want to Have Updated?
Year
Make
Model
Color
Link to Video
Link to What Needs to Be Updated on Social Media
Link to Website
Social Media Request
Website Update Request
Upload Picture of Front of Car

Browse Files

Cancelof
Upload Picture of Driver Side of Car

Browse Files

Cancelof
Upload Picture of Passenger Side of Car

Browse Files

Cancelof
Upload Picture of Rear of Car

Browse Files

Cancelof
Upload Video

Browse Files

Cancelof
Upload Photo

Browse Files

Cancelof
Please Type a Detailed Description of Your Issue Or Suggestion For Improvement.
When would you like the MASS EMAIL to be sent?

Today (must be submitted before 7pm CST M-F)TomorrowASAP/Emergency (Will acommodate if possible)Other
Please type the EXACT message you would like to be mass emailed out to your customers (NOTE -- If service orders are not completed please specify when the customer can expect to receive completion of the service)
PLEASE CLICK HERE FOR - POOP 911 WASTE STATION AND BAGS (**FREE SHIPPING)

PLEASE CLICK HERE FOR - POOP 911 ONLINE SUPPLY STORE - (NOT INCLUDING BAGS OR WASTE STATIONS)

SCOOPING SUPPLIES - LINK TO FRANCHISE RESOURCE CENTER TO SUPPLIES PAGE
Please Provide Any Additional Details that would help us complete this request for you
Please Provide Any Additional Files That Would Help Us Complete This Request For You

Browse Files

Cancelof
Run Into Any Errors? Please Upload a Screenshot of Any Error Messages?

Browse Files

Cancelof
END HERE
What Kind of New Customer Do You Need Help With?

ResidentialCommercial (Apartment, HOA, etc)Event
CLICK HERE TO ADD NEW CUSTOMER http://www.poop911.com
What would you like to do with Scooper?

Activate New ScooperUpdate Existing Scooper InfoDe-Activate Existing Scooper
Scooper Commission %
Date to Activate

MonthDayYear
Date to DE-Activate

MonthDayYear
Marketing / Advertising Request

Create Graphic for BannerCreate Graphic for Door Stickies / HangerCreate Graphic for InternetCreate Graphic for Print (ie - Newspaper, Magazine, etc)Create Vehicle GraphicsLink Exchange with Other Pet Related Web Site that Would help Promote POOP 911Other
What Needs To Be Done To The Customer Account?

ADD - Service (ie-Deodorizer, Patio Hose Off, etc)CANCEL - Cancel Customer AccountCHANGE - Address of Property to ServiceCHANGE - Billing Information (Credit Card or Bank Account Routing/Acct #)CHANGE - Contact InformationCHANGE - Number of Dogs at propertyCHANGE - Current Day of Service to Another DayCHANGE - Gate Code or Combination to Gate LockCHANGE - How Often Property Is ServicedCOMPLAINT - Customer ComplaintPAUSE - Service (ie-Customer going on vacation, work being done on yard, etc)RE-ACTIVATE - Service (Past Customer Returning)REFUND - Issue a Refund Customer AccountOther
What is the Reason for Customer Refund?

DissatisfiedDid Not Receive ServiceBad WeatherOther
What additional services would you like?

DeodorizerHose-off Of Patio or DeckPoop Take AwayWater Bowl Fill UpOther
How Many Dogs Were There Previously?
How Many Dogs Are There Now?
CURRENT Frequency of Service
CURRENT Day(s) of Service

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
NEW REQUESTED Frequency of Service
NEW REQUESTED Day(s) of Service

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
New Gate Code or Lock Combination
Reason For Pausing Service

Family VacationDog Going on VacationWork Being Done to YardOther
Date to Pause Service

MonthDayYear
Type of Customer Complaint

Did not leave YELLOW Sticky (Thank You for Your Business Door Hanger)Did Not Lock GateDid Not Show Up On Correct Day/TimeGate Left OpenDog EscapedRequest RefundNot Sure if Service CompletedNot Sure if Received DeodorizerTechnician did not do a thorough jobOther
Reason for Wanting to Cancel Service*

Going Out of TownGoing to Do it Themselves Going ForwardGoing to CompetitorMovingPoor Service - Billing IssuePoor Service - Don't Show Up on Scheduled Service DayPoor Service - Don't Do A Good JobPoor Service - Left Gate Open / UnlockedPoor Service - Dog EscapedLost Employment/JobToo ExpensiveOther
Customer Date(s) to Apply Refund to (ie- 9/1/2013, 9/3/2013)*
Customer TOTAL Refund Amount
Does Customer Still Wish to Cancel after Refund was offered?

YesNo
Date to Deactivate

MonthDayYear
Customer Willingness to give Credit Card Information

Customer IS comfortable giving credit card informationCustomer IS NOT comfortable giving credit card information and wishes franchise to return call
New Credit Card # (If Credit Card # does not need to be updated just type "SAME")
New Credit Card Expiration Date
Date to Resume Service

MonthDayYear
What is your NEW phone number?

Area CodePhone Number
What is your NEW email address? (All invoices / receipts will be sent to this email address)
example@example.com
What Date Would You Like to RE-ACTIVATE service at your property?

MonthDayYear
Commercial or HOA Property Needs*

Pet Waste Station Installation(s)Restocking of Pet Waste Station BagsTake Away of Pet Waste Station WasteScoop Entire PropertyScoop Only Areas As Indicated by CustomerHose Off of Areas As Indicated by CustomerDeodorizerOther
Heading

All requests will be processed within 24 hours if not sooner. THANK YOU FOR BEING A POOP 911 FRANCHISE!!
Should be Empty:

Franchise Support Request

Heading