Beverage Request Form
Type of Request
*
Please Select
New Install - Water
New Install - Coffee
Machine Down
Upgrading to New Equipment
Small Repair/Needs Cleaning
Remove Machine
GOS Employee Email
*
example@example.com
Company
*
ABC Corporation
Contact Name
*
Customer Email
*
example@example.com
Customer Account Number
*
Phone Number (Cell or Office)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Customer Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this a multiple location install?
Yes
No
Type of Coffee Machine
*
Please Select
Pour Over
Any other machine
Please list the machine(s) at the location that needs service
*
Please list the machine(s) we will be removing from the customers business
*
Please list the machine(s) the customer is upgrading to
*
Water Machines: Please list the machine(s) we will be installing at the customers business
*
Coffee Machines: Please list the machine(s) we will be installing at the customers business
*
Pictures of the location / water source / drain being used
*
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Additional Install Requirements/Comments
If you are submitting a install that requires multiple locations please note that.
Give some detail about the issue with the current machine
*
What service are they needing?
*
Agreements
*
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