New Account Application Form

VannGo Portable Toilets and Luxury Restroom Trailers 615-398-2574

New Account Set Up Agreement
ESTIMATE # (Listed on VannGo PDF quote)
Enter estimate # provided with your quote
Business Name*
FEDERAL EIN#:*
Business Main Phone #:*

Area CodePhone Number
Main Contact

First NameLast Name
E-mail:*
Select Your Sales Rep's Email Address Below*

LISA@GoVannGo.comMICHELLE@GoVannGo.comBILL@GoVannGo.comDAMIAN@GoVannGo.comPRUDENCE@GoVannGo.comMEGAN@GoVannGo.comSOMMER@GoVannGo.comTARYN@GoVannGo.comLILY@GoVannGo.comKAYLA@GoVannGo.comOther
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Purchasing Agent Information
Purchasing Contact*

First NameLast Name
Purchasing Phone*

Area CodePhone Number
Purchasing Fax

Area CodePhone Number
Purchasing Email*
example@example.com
Is this the email address where invoices should be sent?*

YESNO
Purchasing Address (if different than Billing Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Principal/Partner Information
Payment/Banking Information
Preferred Payment Method

Bank transferCheck (Upon Approval)Visa/Mastercard/AmexCredit Terms/Net 30 (Upon Approval)
Bank Name (If Bank Transfer or Check is Preferred Payment Method)
Phone Number

Area CodePhone Number
Account Type
Bank Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
JOB/PROJECT DETAILS
Start Date (If Applicable)

MonthDayYear
Estimated End Date (If Applicable)

MonthDayYear
You must call us to schedule pick up. The end date is only an estimation and a schedule will not be built upon that.

Company’s rates are for the entire Period, which shall not be prorated (i.e., charges for less than a full Period shall not be prorated). No refunds shall be issued when pick up request is received after invoice creation.
DELIVERY ADDRESS (LUGAR DE ENTREGA)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SITE CONTACT*
SITE CONTACT PHONE #*

Area CodePhone Number
EQUIPMENT
TYPE OF RENTAL
Select Equipment for Project/Construction Rental

Construction site standard portable toiletWheel Chair Accessible PortableExterior Hand Wash Sink (Includes soap dispensers and soap packs)Exterior Hand Sanitizer Station (Includes sanitizer pouches)Waste Water Tank/System (Does not include plumbing installation)Fresh Water Supply Tank - Does not include Plumbing Installation (Client is responsible for protecting fresh water supply tanks from freezing during winter temperatures. Ice will break the water pump which will not be replaced by VannGo under normal service. Additional charges will incur for water pump and parts replacement.)Interior Hand Sanitizer Dispenser (adds $25 monthly)
Select Equipment for Event Rental

Event Portable."COMING UP ROSES" Rose-Scented Event PortableWheel Chair Accessible PortableExterior Hand Wash Sink (Includes soap dispensers and soap packs)40 Gallon Trash Can With Liner (add quantities below)Exterior Hand Sanitizer Station (Includes sanitizer pouches)Waste Water Tank/System (Does not include plumbing installation)Fresh Water Supply Tank - Does not include Plumbing Installation (Additional charges will incur for water pump and parts replacement.)
Add Frequency of Services, Unit Quantities, Job Name(s), Notes Here
Example: Trailer needs water and power generator. (None Avail onsite)

ACCESSING THE SERVICE LOCATION*

	YES	NO	if yes, enter Combo for lock
Does the service location have a gated entrance?
Does the service location need a key for entry?
Does the service location have a lock on the entry?
If there is a lock, is it a combination lock?

LOCKED LOCATION - Customer acknowledges and accepts that No refunds are eligible for "unable to service" locations with locked gates/keys/lock boxes. If the location needs to be secured with a lock, a combination lock is the only VPS approved option.**
TYPE NAME TO ACKNOWLEDGE AND ACCEPT.
TRAILERS

Select Equipment for Project/Job Rental
CHECK ALL THAT APPLY

2 ROOM3 ROOM4 ROOM5 ROOM8 ROOM9 ROOMADA + 2 ROOMPortable Generator
PUMPING - RESTOCKING - WATER FILL Check All That Are Needed

PUMPING SERVICERESTOCKING SERVICEFRESH WATER FILL
PLEASE ACCEPT OR DECLINE YOUR DAMAGE WAIVER PROTECTION (Full details about the program can be reviewed by clicking "terms & conditions" below.)*

I ACCEPT THE DAMAGE WAIVER.I DECLINE THE DAMAGE WAIVER. (I WILL PAY THE FULL COST OF ANY LOSS OR DAMAGE)
Should be Empty:

VannGo Portable Toilets and Luxury Restroom Trailers 615-398-2574

Purchasing Agent Information

Principal/Partner Information

Payment/Banking Information

JOB/PROJECT DETAILS

EQUIPMENT

TRAILERS