New Customer Form

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 ELECTRONIC SIGNATURE THAT I HAVE READ AND UNDERSTAND THE POLICY ABOVE

My Signature *Type in your signature
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 *
Opt Into Text Alerts- Write Yes or No *

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

Name On Card *
Credit Card Number *
Address Including Street Name & Number *
City *
State *
Zip Code *
EXP. *
CVV *
Cardholder Signature *Type your signature here.
Cardholder Email *

*Billing / Accounts Payable Contact

Name *
Phone *
Email *

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
GA County
Zip Code
Company Phone
Company Email
Do You Require a Certificate of Insurance? *Yes or No
Equipment Type
Description Of Problem
Make, Model, Serial Number
Standard Service Monday-Friday 8:00-5:00 Answer Yes or No
Emergency Service/Overtime Rates Answer Yes or No

Verification

Please enter any two digits *Example: 12
This box is for spam protection – <strong>please leave it blank</strong>:

Our regular business hours are Monday to Friday from 8:00 AM until 5:00 PM.

Please leave us a voice message if you have an emergency overtime service needed. Please call our main office number and follow the prompts from the auto attendant to leave a voicemail on the emergency service mail box.

Atlanta Equipment Company

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

SERVING METRO ATLANTA AND NORTH GA

New Customer Form

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

MY ELECTRONIC SIGNATURE THAT I HAVE READ AND UNDERSTAND THE POLICY ABOVE

Service Location Information

Repair Estimates and Invoice Contact

General Service and Appointment Updates Contact

Emergency Contact

Credit Card Billing Information

*Billing / Accounts Payable Contact

Accounts Payable Information

PLEASE FILL OUT THIS SECTION IF YOUR BUSINESS HAS MULTIPLE LOCATIONS

Verification

Our regular business hours are Monday to Friday from 8:00 AM until 5:00 PM.

Please leave us a voice message if you have an emergency overtime service needed. Please call our main office number and follow the prompts from the auto attendant to leave a voicemail on the emergency service mail box.

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Atlanta Equipment Company

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

SERVING METRO ATLANTA AND NORTH GA

New Customer Form

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*

*MY ELECTRONIC SIGNATURE THAT I HAVE READ AND UNDERSTAND THE POLICY ABOVE*

Service Location Information

Repair Estimates and Invoice Contact

General Service and Appointment Updates Contact

Emergency Contact

Credit Card Billing Information

*Billing / Accounts Payable Contact

Accounts Payable Information

*PLEASE FILL OUT THIS SECTION IF YOUR BUSINESS HAS MULTIPLE LOCATIONS*

Verification

Our regular business hours are Monday to Friday from 8:00 AM until 5:00 PM.

Please leave us a voice message if you have an emergency overtime service needed. Please call our main office number and follow the prompts from the auto attendant to leave a voicemail on the emergency service mail box.

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ALL NEW ACCOUNTS ARE REQUIRED TO HAVE A VALID CREDIT CARD ON FILE PRIOR TO SERVICE

MY ELECTRONIC SIGNATURE THAT I HAVE READ AND UNDERSTAND THE POLICY ABOVE

PLEASE FILL OUT THIS SECTION IF YOUR BUSINESS HAS MULTIPLE LOCATIONS