1 — Customer information
Rep use only. Complete this form, review the calculated amounts, then email the agreement to the customer for signature. The customer will not see this entry form.
Please complete customer legal name, email, telephone, billing address, and agreement date.
2 — Equipment and pricing
Choose one or more bottleless products. Use Add another product when the customer needs different models or quantities. Each row is totaled into the agreement.
BLC RO Hot / Cold without Ice · $90.00/mo · $149.00 install
For each row: select the model, enter the number of units, and verify the per-unit monthly and installation amounts.
Please enter a valid quantity, monthly payment, installation cost, and term.
3 — Review and send for signature
Please confirm the agreement before sending.
The customer receives a signing link. The signed PDF is emailed to the sales representative through the existing Culligan workflow.