BBL Keg Request

Request is for:*

New Keg PurchaseKeg Exchange (Repeat Customer)

Requested Pick Up Date - Allow up to a week for order to be fulfilled. If needing keg sooner please call 913.764.0816 for availability.

Date

Name*

First NameLast Name

Email

example@example.com

Phone Number*

Please enter a valid phone number.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Driver's License or ID # - State of Issue*

Date of Birth (Verified at time of purchase)*

Date

Last 4 of Credit Card

*Notify customer that deposits can only be refunded to the orginal form of payment and the person who paid deposit.

Deposit Paid in Cash

*Notify customer that deposits can only be refunded to the orginal form of payment and the person who paid deposit.

Total Deposit

*Keg Shell - $50/ea, Tap - $60/ea, Tub - $50/ea - If there is no deposit please type NO DEPOSIT and the reason in this field.

Requested Keg 1:

What beer would like in your keg? (Not all beers are available in kegs. We will let you know asap if your request is not available)

Requested Size 1:

Select your preferred keg size (not all kegs are available in all sizes)

Keg 1 Tag Number

*6 Digit Number from tag attached to keg. Each keg purchased will need it's own tag.

TAP Number(s)

If more than one tap is borrowed separate numbers with comma. e.g. T01, T08, T09

TUB Number(s)

If more than one tap is borrowed separate numbers with comma. e.g. B01, B08, B09

Requested Equipment:

All Equipment: Tap, Barrel & Keg Shell ($160 Deposit)Tap + Keg Shell ($110 Deposit)Barrel + Keg Shell ($100 Deposit)Keg Only ($50 Deposit)

Even Exchange/Deposit:

Even Exchange ($0 - Keg Shell Swap)

Pricing Request 1:

Send pricing before reservingReserve without price quote

Would you like to request another keg?

YesNo

Requested Keg 2:

What beer would like in your keg? (Not all beers are available in kegs. We will let you know asap if your request is not available)

Requested Size 2:

Select your preferred keg size (not all kegs are available in all sizes)

Keg 2 Tag Number

Pricing Request 2:

Send pricing before reservingReserve without price quote

Requested Equipment:

All Equipment: Tap, Barrel & Keg Shell ($160 Deposit)Tap + Keg Shell ($110 Deposit)Barrel + Keg Shell ($100 Deposit)Keg Only ($50 Deposit)Even Exchange ($0 - Keg Shell Swap)

Would you like to request another keg?

YesNo

Requested Keg 3:

What beer would like in your keg? (Not all beers are available in kegs. We will let you know asap if your request is not available)

Requested Size 3:

Select your preferred keg size (not all kegs are available in all sizes)

Keg 3 Tag Number

Pricing Request 3:

Send pricing before reservingReserve without price quote

Requested Equipment:

All Equipment: Tap, Barrel & Keg Shell ($160 Deposit)Tap + Keg Shell ($110 Deposit)Barrel + Keg Shell ($100 Deposit)Keg Only ($50 Deposit)Even Exchange ($0 Keg Shell Swap)

Would you like to request another keg?

YesNo

Requested Keg 4:

What beer would like in your keg? (Not all beers are available in kegs. We will let you know asap if your request is not available)

Requested Size 4:

Select your preferred keg size (not all kegs are available in all sizes)

Keg 4 Tag Number

Requested Equipment:

All Equipment: Tap, Barrel & Keg Shell ($160 Deposit)Tap + Keg Shell ($110 Deposit)Barrel + Keg Shell ($100 Deposit)Keg Only ($50 Deposit)Even Exchange ($0 Keg Shell Swap)

Pricing Request 4:

Send pricing before reservingReserve without price quote

Notes:

I certify that the information on this form is true to the best of my knowledge and belief.

• I am over the legal age to purchase, possess and consume beer.
• I understand that it is unlawful to resell this product.
• I understand that it is unlawful to allow consumption of the product by any person who is not of legal age.
• I understand that it is unlawful to remove the numbered tag attached to the keg(s).

I'm aware that all equipment must be returned in good working condition within 2 days or my deposit will be forfeited. Deposit will only be returned as the original form of payment.

Signature

Reserved/put on hold by:

Put on hold:

Date

Keg Status (Employee Use Only)