Madtown Machines Customer Interest Form
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your zip code within Dane County?
*
What type of property do live in?
*
House
Townhouse
Apartment
If not ground floor, what floor are you on? Is there an elevator?
Are there a pre-existing washer/dryer hookups on your property?
*
Yes
No
Other
Is your property compatible with electric dryers? We only offer service on electric dryers, not gas.
*
Yes
No
Is there a dryer vent?
*
Yes
No
Is the outlet for your dryer 3 or 4 pronged?
*
3
4
Other
Do you have pre-existing washer/dryers that need to be removed from the property prior to installation? If so, that will be an additional $50.
*
Yes, I consent to paying $50 for removal.
No
Any other questions before scheduling your installation?
*
Yes
No
Add additional questions here:
Our standard operating hours are weekends and select weeknights. What works best for you?
*
Saturday
Sunday
Monday evening
Tuesday evening
Wednesday evening
Thursday evening
Friday evening
What is your preferred delivery date in the next 2-weeks? We will do our best to accommodate.
Note: Your card will not be charged today. We collect payment information to secure your machines and create your customer profile. We will only process the first month's payment once we’ve installed your set. If you still have questions, feel free to submit the form without this information and we will call you to confirm.
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Washer + Dryer Set Rental – Standard 12 Months
(
$
60.00
for
1 month
)
Washer + Dryer Set Rental – Standard 6 Months
(
$
65.00
for
1 month
)
Washer + Dryer Set Rental – Standard 3 Months
(
$
80.00
for
1 month
)
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Request Installation & Secure My Rate
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