Please fill out the form below to complete installation and customer registration.

1 Step 1

Installation Form

End User Business Name

City

State

Select An OptionNOT LISTEDAK AlaskaAL AlabamaAR ArkansasAZ ArizonaCA CaliforniaCO ColoradoCT ConnecticutDC District of ColumbiaDE DelawareFL FloridaGA GeorgiaHI HawaiiIA IowaID IdahoIL IllinoisIN IndianaKS KansasKY KentuckyLA LouisianaMA MassachusettsMD MarylandME MaineMI MichiganMN MinnesotaMO MissouriMS MississippiMT MontanaNC North CarolinaND North DakotaNE NebraskaNH New HampshireNJ New JerseyNM New MexicoNV NevadaNY New YorkOH OhioOK OklahomaOR OregonPA PennsylvaniaRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVA VirginiaVT VermontWA WashingtonWI WisconsinWV West VirginiaWY Wyoming

Country

Select an OptionUS United StatesCA CanadaMX MexicoAD AndorraAE United Arab EmiratesAF AfghanistanAG Antigua and BarbudaAI AnguillaAL AlbaniaAM ArmeniaAN Dutch AntillesAO AngolaAQ AntarcticaAR ArgentinaAS American SamoaAT AustriaAU AustraliaAW ArubaAZ AzerbaijanBA Bosnia and HerzegovinaBB BarbadosBD BangladeshBE BelgiumBF Burkina FasoBG BulgariaBH BahrainBI BurundiBJ BeninBM BermudaBN Brunei DarussalamBO BoliviaBR BrazilBS BahamasBT BhutanBV Bouvet IslandsBW BotswanaBY BelarusBZ BelizeCC Coconut IslandsCD Democratic Republic of the CongoCF Central African RepublicCG Republic of the CongoCH SwitzerlandCI Cote d'IvoireCK Cook IslandsCL ChileCM CameroonCN ChinaCO ColombiaCR Costa RicaCS Serbia and MontenegroCU CubaCV Cape VerdeCX Christmas IslndCY CyprusCZ Czech RepublicDE GermanyDJ DjiboutiDK DenmarkDM DominicaDO Dominican RepublicDZ AlgeriaEC EcuadorEE EstoniaEG EgyptEH West SaharaER EritreaES SpainET EthiopiaFI FinlandFJ FijiFK Falkland IslandsFM MicronesiaFO Faroe IslandsFR FranceGA GabonGB United KingdomGD GrenadaGE GeorgiaGF French GuianaGH GhanaGI GibraltarGL GreenlandGM GambiaGN GuineaGP GuadeloupeGQ Equatorial GuineaGR GreeceGS South Georgia and the South Sandwich IslandsGT GuatemalaGU GuamGW Guinea-BissauGY GuyanaHK Hong KongHM Heard and McDonald IslandsHN HondurasHR CroatiaHT HaitiHU HungaryID IndonesiaIE IrelandIL IsraelIM United KingdomIN IndiaIO British Indian Ocean TerritoryIQ IraqIR IranIS IcelandIT ItalyJM JamaicaJO JordanJP JapanKE KenyaKG KyrgyzstanKH CambodiaKI KiribatiKM ComorosKN Saint Kitts and NevisKP North KoreaKR South KoreaKW KuwaitKY Cayman IslandsKZ KazakhstanLA LaosLB LebanonLC St. LuciaLI LiechtensteinLK Sri LankaLR LiberiaLS LesothoLT LithuaniaLU LuxembourgLV LatviaLY LibyaMA MoroccoMC MonacoMD MoldovaMG MadagascarMH Marshall IslandsMK MacedoniaML MaliMM MyanmarMN MongoliaMO MacauMP North Mariana IslandsMQ MartiniqueMR MauritaniaMS MontserratMT MaltaMU MauritiusMV MaldivesMW MalawiMY MalaysiaMZ MozambiqueNA NamibiaNC New CaledoniaNE NigerNF Norfolk IslandsNG NigeriaNI NicaraguaNL NetherlandsNO NorwayNP NepalNR NauruNU NiueNZ New ZealandOM OmanPA PanamaPE PeruPF French PolynesiaPG Papua New GuineaPH PhilippinesPK PakistanPL PolandPM Saint Pierre and MiquelonPN Pitcairn IslandsPR Puerto RicoPS Palestinian Autonomy AreaPT PortugalPW PalauPY ParaguayQA QatarRE ReunionRO RomaniaRU Russian FederationRW RwandaSA Saudi ArabiaSB Solomon IslandsSC SeychellesSD SudanSE SwedenSG SingaporeSH St. HelenaSI SloveniaSJ SvalbardSK SlovakiaSL Sierra LeoneSM San MarinoSN SenegalSO SomaliaSR SurinameST Sao Tome and PrincipeSV El SalvadorSY SyriaSZ SwazilandTC Turks and Caicos IslandsTD ChadTG TogoTH ThailandTJ TajikistanTK Tokelau IslandsTM TurkmenistanTN TunisiaTO TongaTP East TimorTR TurkeyTT Trinidad and TobagoTV TuvaluTW TaiwanTZ TanzaniaUA UkraineUG UgandaUM American Minor Outlying IslandsUY UruguayUZ UzbekistanVA Vatican CityVC Saint Vincent and the GrenadinesVE VenezuelaVG British Virgin IslandsVI American Virgin IslandsVN VietnamVU VanuatuWF Wallis and FutunaWS Western SamoaYE YemenYT MayotteYU Serbia and MontenegroZA South AfricaZM ZambiaZW Zimbabwe

Zip Code

Site Contact First Name

Site Contact Last Name

Site Contact Email

email

Site Contact Phone

Dealer Name

Dealer Address

Dealer Phone

Installing Rep First Name

Installing Rep Last Name

Installing Rep Email

email

Installing Rep Phone

Sales Rep Name

Sale Rep Email

email

Sales Rep Phone

Machine Model

Please SelectAMR (Robot)Apex 47Apex 58Armadillo SeriesAtlasCollector SeriesNautilus SeriesPhoenix SeriesScrubmaster B120Scrubmaster B175Scrubmaster B260Scrubmaster B400Sweepmaster 1500Other

Machine Serial Number

Engine Serial #Only IC Machines (Optional)

Upload image of Machine Serial NumberRequired

cloud_uploadUpload

Date of Delivery

date_range

Hour Meter Reading

Original Invoice Number

Upload image of Hour MeterRequired

cloud_uploadUpload

Dealer to Provide Service

YesNo

Are you installing on behalf of another dealer/seller (Authorized Ship-In)?

YesNo

I verify all of the information provided is correct.

Yes

E-Signature

Date

date_range

Submit

keyboard_arrow_leftPrevious

Nextkeyboard_arrow_right

FormCraft - WordPress form builder