New Customer Registration Form

Please select how many machines you would like to purchase or lease.*

36 Month Lease (Monthly Fee)

Lease only available for C-Stores or customers who have approved business credit. Minimum 2 years in business with a Commercial Paydex of 600+

$89.00 Quantity

24 Month Lease (Monthly Fee)

Available to restaurants and foodservice customers only. Lease is 24 months and subject to credit approval.

$120.00 Quantity

PURCHASE (One Time Fee)

FROZE UP! Branded Frozen Machine (2) Easy to clean barrels LED Lids to display productLED Backlight for Froze Up! graphics

$2,995.00 Quantity

Total

$0.00

Who is filling out this form?

First NameLast Name

Please select a distributor that will deliver your product.*

What is your Taxpayer Idenitificaiton Number? TIN/EIN*

What is the legal name of customer's LLC, S-Corp as filed with the Secretary of State?*

Is this location Doing Business As (DBA) something else? If so please indicate what this location is known by...*

Where will the equipment installation be located?*

Street Address

CityState

Zip Code

Who is the contact at this location?*

First NameLast Name

What is the owners email address?*

example@example.com

What is the store owners direct phone number?*

Format: (000) 000-0000.

Tell us about your store.