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3 & 5 Gallon Bottled Water
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2023-01-26T22:58:49+00:00
Delivery Address
Name
Address
Street Address
Street Address Line 2
City
State
Zip Code
Contact Person
First
Last
Email
*
Billing Address (If different)
Billing Address
Street Address
Street Address Line 2
City
State
Zip Code
Phone (Home)
Phone (Cell)
Phone (Work)
Delivery Instructions
Product Information
Item Description
Qty
Price each
Total
Cooler Type
Water
Cups
Other
Bottle Deposits
Order Date
Customer Type
Residential
Commercial
Referred by
Statement
Emailed
Mailed (+ $1.50 per month)
Equipment rent, setup fees, and unused water are nonrefundable.
Without Idaho Ice's consent customer will not remove/relocate the water dispenser from service address listed on this application.
Customer will take reasonable care of water dispenser and any other Idaho Ice equipment on their premises. Customer will allow Idaho Ice reasonable access to inspect Idaho Ice property located on their premises. Customer will allow Idaho Ice representative access to their residence to remove Idaho Ice property upon termination of this lease.
Customer will NOT perform service or make repairs to the water dispenser. Customer will NOT refill Idaho Ice water bottles with any other water. Idaho Ice will provide any service and maintenance to Idaho Ice equipment at no additional expense to the customer. Idaho Ice is NOT liable for any consequential or incidental damage which may arise out of customers use of water dispenser and/or water service including fire, water, or electrical damage.
If you fail to pay your account and Idaho Ice has to turn the account over to collection you will be charge full retail of the water dispenser, if you have failed to return it to us as requested.
In the event you (the customer) default in payment for services rendered and usage of equipment in your possession, this account may be placed with an attorney and/or collection agency. The undersigned agrees to pay all attorneys fees and court costs.
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