New Customer Form
P: 0431 187 667 E: onthespotfilterclean.com.au
Business Details
Entity Name
Trading Name (T/A)
*
ABN
Contact Name
*
First Name
Last Name
Phone Number
*
E-mail
*
example@example.com
Restaurant Address
*
Please include street number, name and suburb
Accounts Contact Details
If different from above
Contact Name
First Name
Last Name
Phone Number
E-mail
example@example.com
Service Details
How many filters?
*
Filter Type?
*
Please text a photo of your rangehood filters to 0431 187 667
Photo of Filters
Browse Files
Drag and drop files here
Choose a file
Cancel
of
How often would you like them changed?
*
eg. 2 weeks, 4 weeks etc
Zone / Area?
(OTS employee to complete)
Opening hours
*
Price per filter?
Price confirmed by OTS employee only. Price is excluding GST.
Before hours access?
*
If yes, please complete below.
Before hours access?
Key
Key Lock Box (Please provide code below)
Alarm (Please provide code below)
Person present
Lock box / alarm code?
Please include location of lock box & codes
Proposed Service date?
*
+ 2 weeks
+ 4 weeks
Urgent (Within 1 week - An additional once-off fee may apply)
Payment options
Direct Debit (Please complete our Direct Debit Agreement and provide CVV to Rep or SMS 0431 187 667)
Bpay (due within 7 days of service date, unless otherwise agreed)
Cash (paid on the day of service)
Additional Information
Special notes if required
Signed & Agreed By
*
First Name
Last Name
Date
*
-
Day
-
Month
Year
Date Picker Icon
Signature
Submit
Submit
Should be Empty: