Date

Store Number

Street Address

City

State

Zip Code

Franchisee Name

Site Contact Name

Site Contact Mobile Phone

Site Contact Email

Store Design Store Design Modern Single Modern Dual Image

If you currently have a Grill, what is the model #

EWXPAC Warranty Options EWXPAC Warranty Options One year additional warranty ($1,200) Two year additional warranty ($2,400) Three year additional warranty ($3,600) Four year additional warranty ($4,800)

EWPXPAC Warranty Options (Overtime Hours) EWPXPAC Warranty Options (Overtime Hours) One year PM program ($1,290) Two year PM program ($2,580) Three year PM program ($3,870) Four year PM program ($5,160)

Install Type Install Type New Build Scrape & Rebuild Replacement of existing grill

Date Grill is desired on Site

Date of Startup