Electro Freeze Pre-Start-Up Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Pre-Start-Up Checklist The following information is needed before the demonstration and start-up of Electro Freeze Equipment. Please verify all information and submit this form. Requested Start-Up Date *A 2 WEEK LEAD TIME IS NEEDEDCompany/Location *Store #Street Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeOn-Site Contact Name *FirstLastPhone *Email *EquipmentModel #Serial #ConnectionsHave the proper electrical requirements been met? *YesNoIs the water line installed? *YesNoNot applicableNeccessary Start-up ItemsStart-up box on site and available *YesNoIs the product available and ready for install? *YesNoIs the unit in place/installed? *YesNoAdditional ContactsContact 1 NameEmailCompanyPhoneContact 2 Name Email Company Phone Contact 3 NameEmail CompanyPhoneCall 24 hours in advance of the scheduled appointment to cancel. Takes 2-3 weeks to get an appointment after this form is returned. I have confirmed all the required information to schedule the start-up. If the proper power, water, mix, or personnel requirements listed are not available at the time designated and result in a second trip to finalize installation I agree to pay the trip charges. Signature Clear Signature Printed Name *FirstLastPrinted Title *Submit
