Clarke CA30 20B

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Schedule a Service Call

Name*
Company Name*
Email*
Phone*
Ext
Repair Urgency
- Urgent
- Not Urgent
Date Requested
MM slash DD slash YYYY
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Problems Occurring
Special Instructions
Machine Information (help us with whatever info you know)
Brand Name
Type*
Other
Model
Serial Number
Seeking Information on reconditioning program
- Yes
Seeking information on Planned Maintenance programs (PM’s)
- Yes
Phone
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95421

Schedule A Rental

Your Name*
Company Name*
Email*
Phone*
Click if same
- Click if same
Jobsite Contact
Phone
Hazardous or Flammable Materials*
- I certify unit will not be used with floor sealers, strippers, densifiers or flammable materials
Type of Rental Unit
- LP Gas Rider Sweeper
- LP Gas Rider Scrubber
- Battery Rider Scrubber
- Battery Walk Behind Scrubber
- Gas Pressure Washer
- Electric Pressure Washer
- Surface Cleaner
(Please note: LP tank not included with machine cost and is extra)
Need LP
- Yes
- No
Number of Tanks
Floor Condition
- New, no high gloss coating
- High gloss or coated floor
- Plain concrete
Plain Concrete
- Rough
- Average
- Smooth
Desired Brush
Brush
- Aggressive
- Medium
- Soft
- Pads
Pad Color
Type of Dirt
- Oil
- Metal Chips
- Dust
- Tire Marks
- General Dirt
Need Chemicals
- Yes
- No
Does Application Include:
- Parking Garage
- Hazardous or Flammable Material
Building Access
- Dock
- Ground & Ramp
- Both
Date Needed
MM slash DD slash YYYY
Date Returning
MM slash DD slash YYYY
Special Instructions
Comments
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86219