Home Prepaid Water Tank Cleaning Form Prepaid Water Tank Cleaning Form First Name *Last Name *Phone *ExtensionEmail Address *Street Address *Apartment, suite, etcPower Accessibility *YesNoWe require power to run our equipment, is it accessible for us?Parking & Tank Accessibility *YesNoWe need to be able to park close enough to run our hoses (about 15 meters) and access to at least one side of the tank. Is this possible?Is 2 feet above the tank accessible? *YesNoWe need at least 2 feet of clearance above your tank to get our equipment in and perform the cleaning, is this possible?Size of Water Tanks *If you are not sure of exact size a guess is fineIn Town or Out of Town? *In TownOut of TownPlease note any tanks out of town are an additional $50.00 charge to cover our gas and time.# of Tanks to Clean *Please indicate how many tanks you need cleaned. Pricing is per tank.What Day of The Week Do You Get Your Water Delivered?MondayTuesdayWednesdayThursdayFridayWater Tank Picture(s)Drag and Drop (or) Choose FilesPlease attach any photos of your water tank to give us an idea of what we will be dealing with.Additional DetailsLet us know if there are special instructionsCalculationsCredit / Debit Card *Submit Order
