Customer Account

ALL CREDIT CARDS PROVIDED ARE SUBJECT TO PRE-AUTHORIZATION PRIOR TO SERVICE.

ATTENTION NEW CUSTOMERS

Before filling out the form below, please read the

conditions, sign and date. This acknowledges that you

understand and agree.

*ALL NEW ACCOUNTS ARE REQUIRED TO

HAVE A VALID CREDIT CARD ON FILE PRIOR

TO SERVICE*

ATLANTA EQUIPMENT IS A FACTORY AUTHORIZED INDEPENDENT PROVIDER AND IS NOT RESPONSIBLE FOR COVERAGE TERMS OR CONDITIONS, DETERMINED BY THE MANUFACTURER.

ANY AND ALL APPLICABLE DIAGNOSTIC OR REPAIR CHARGES FOR STANDARD, EMERGENCY OR NON- WARRANTY SERVICE REQUESTS WILL BE BILLED TO THE ACCOUNT CREDIT CARD ON FILE. INFORMATION WILL BE KEPT ON FILE FOR FUTURE SERVICES.

ALL FACTORY APPROVED WARRANTY CHARGES WILL BILL DIRECTLY TO THE MANUFACTURER.

BY SUBMITTING YOUR CREDIT CARD INFORMATION, YOU ACKNOWLEDGE THAT YOU HAVE READ AND UNDERSTAND THE TERMS AND CONDITIONS AND CONFIRM THAT ATLANTA EQUIPMENT IS AUTHORIZED TO CHARGE YOUR CARD FOR OUR SERVICES.

My Signature * *

Type in your signature and the Date

Service Location Information *

Name Of Service Location * Service Location Phone *

Physical Service Address *

including street name and number* City * GA/County * Zip Code *

Persons Authorized to Place Service Requests *

Name/s *

Repair Estimates and Invoice Contact *

Name * Phone * Email *

General Service and Appointment Updates Contact *

Name * Phone * Email *

Emergency Contact *

Name * Phone

Credit Card Billing Information *

Namre On The Card

Credit Card Number *

Address Including Street Name & Number * City * State * Zip Code *

Rates You

EXP *

CW *

Cardholder Signature *

Type your signature above

Cardholder Email *

*Billing / Accounts Payable Contact *

Name * Phone *

Accounts Payable Information *

*PLEASE FILL OUT THIS SECTION IF YOUR BUSINESS HAS MULTIPLE LOCATIONS* Name of Company / Responsible Party: Physical Address Including Street Name And Number, city, and zip code

Company Phone And Company Email *

Do You Require a Certificate of Insurance? *

Equipment Type

Description Of The Problem

Make, Model, and Serial Number

Standard Service - Monday-Friday 8:00-5:00

Emergency Service- Overtime Rates

How Did You hear About Us? *

Atlanta Equipment Company

We are your experts in commercial kitchen equipment service and repair.

SERVING METRO ATLANTA AND NORTH GA