New Account Application Form

VannGo Portable Toilets and Luxury Restroom Trailers 615-398-2574

New Account Set Up Agreement
ESTIMATE # (Listed on VannGo PDF quote)
Enter estimate # provided with your quote
Business Name*
FEDERAL EIN#:*
Business Main Phone #:*

Area CodePhone Number
Main Contact*

First NameLast Name
E-mail:*
Billing Email (if different than above):
example@example.com
Select Your Sales Rep's Email Address Below*

LISA@GoVannGo.comMICHELLE@GoVannGo.comBILL@GoVannGo.comDAMIAN@GoVannGo.comPRUDENCE@GoVannGo.comMEGAN@GoVannGo.comSOMMER@GoVannGo.comTARYN@GoVannGo.comLILY@GoVannGo.comKAYLA@GoVannGo.comOther
Delivery Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Billing Address (if the different from Delivery address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SITE CONTACT*
SITE CONTACT PHONE #*

Area CodePhone Number
JOB/PROJECT DETAILS
Start Date (If Applicable)

MonthDayYear
Estimated End Date (If Applicable)

MonthDayYear
If your rental is not for a weekend event, you MUST contact our office to schedule pick-up. The end date listed above is for estimation purposes only and does not automatically schedule a pick-up.

VannGo invoices in advance on a 28-day cycle. Invoiced amounts are for the entire period, which shall not be prorated (i.e., charges for less than a full period shall not be prorated). NO REFUNDS/ADJUSTMENTS SHALL BE ISSUED WHEN PICK UP REQUEST IS RECEIVED AFTER INVOICE CREATION.
Payment Information
Preferred Payment Method

Visa/Mastercard/AmexACH (Upon Approval ONLY)Credit Terms (Upon Approval ONLY. Net 15 then Net 30 After three consecutive on-time payments )Check (Upon Approval ONLY)
EQUIPMENT
TYPE OF RENTAL
Select Equipment for Construction Rental

Construction site standard portable toiletWheelchair Accessible PortableExterior Hand Wash Sink (Includes soap dispensers and soap packs)Exterior Hand Sanitizer Station (Includes sanitizer pouches)Waste Water Tank/System (Does not include plumbing installation)Fresh Water Supply Tank - Does not include Plumbing Installation (Client is responsible for protecting fresh water supply tanks from freezing during winter temperatures. Ice will break the water pump which will not be replaced by VannGo under normal service. Additional charges will incur for water pump and parts replacement.)Interior Hand Sanitizer Dispenser (adds $25 monthly)
Select Equipment for Event Rental

Event PortablePink Event Portable ($11 extra)Wheelchair Accessible PortableExterior Hand Wash Sink (Includes soap dispensers and soap packs)40 Gallon Trash Can With Liner ($20 ea. extra. Add quantities below)Exterior Hand Sanitizer Station (Includes sanitizer pouches)Waste Water Tank/System (Does not include plumbing installation)Fresh Water Supply Tank - Does not include Plumbing Installation (Additional charges will incur for water pump and parts replacement.)
Storms and high winds can sometimes cause portable restrooms to tip over. To help prevent this, we offer an anchor kit for an additional $15 per unit.*

Yes, please add anchor kits to my order ($15 per unit).No, I decline the anchor kit option.
Add Frequency of Services, Unit Quantities, Job Name(s), Notes Here
Example: Trailer needs water and power generator. (None Avail onsite)

ACCESSING THE SERVICE LOCATION*

	YES	NO	if yes, enter Combo for lock
Does the service location have a gated entrance?
Does the service location need a key for entry?
Does the service location have a lock on the entry?
If there is a lock, is it a combination lock?

LOCKED LOCATION - Customer acknowledges and accepts that No refunds are eligible for "unable to service" locations with locked gates/keys/lock boxes. If the location needs to be secured with a lock, a combination lock is the only VPS approved option.**
TYPE NAME TO ACKNOWLEDGE AND ACCEPT.
CHECK ALL THAT APPLY

2 ROOM3 ROOM4 ROOM5 ROOM8 ROOM9 ROOMADA + 2 ROOMPortable Generator
PUMPING - RESTOCKING - WATER FILL Check All That Are Needed

PUMPING SERVICERESTOCKING SERVICEFRESH WATER FILL
PLEASE ACCEPT OR DECLINE YOUR DAMAGE WAIVER PROTECTION (Pricing and details about the program can be reviewed by clicking "terms & conditions" below.)*

I ACCEPT THE DAMAGE WAIVERI DECLINE THE DAMAGE WAIVER. (I WILL PAY THE FULL COST OF ANY LOSS OR DAMAGE)
Should be Empty:

VannGo Portable Toilets and Luxury Restroom Trailers 615-398-2574

JOB/PROJECT DETAILS

Payment Information

EQUIPMENT