Equipment Removal Form Fill out the form for every removal service Equipment Removal Form All entries with an asterisk are required before submission. An images of equipment being removed must be submitted for payment. More than one image or video is preferred Name Purchase Order/Service Request Number Date Name of Store Location Time-in Manager On Site Please Confirm All Fountain flushed and sanitized on site during removal. Flushed with warm water and sanitized through all bib pumps and valves All otikers/clamps along with the cut tubing is removed from barbed fittings on fountain and components Fountain, valves & all components wiped clean Legs and valves removed and placed inside separate box for shipping purposes List of the Equipment Removed Does the Unit have an Ice Machine? yes no Dispenser Model/Serial Number Image of Dispenser Additional Images/Files Tech Notes or Comments Time-Out On-site Manager Signature Send
