NextGen Dairy Valve Form - next location - SureShot Solutions : SureShot Solutions

* Required field. If required fields are not filled out, the form cannot be submitted.

Name / nom*

First Name / Prénom*

Last Name / Nom de famille*

Phone / Téléphone*

Email / Courriel*

Restaurant # / # du restaurant*

If entering information for more than one location, please fill out a separate form for each restaurant. Once you have finished filling out this form, click on the Submit button and a link to this form will be provided again on the confirmation page.

Shipping Address / Adresse de livraison*

Street Address / Adresse de rue*

City / Ville*

State/Province / Etat/Province*

Postal Code / Code Postal*

Serial Number / Numéro de série

AC220-V2 Serial Number / Numéro de série

The serial number is 4 numbers, followed by a dash and six more numbers (i.e., 0522-123456). If you have more than one AC220-V2 Next Generation dairy dispenser at this restaurant location, please enter the serial number for each additional dispenser below. If not, please leave the space blank.

Serial number / Numéro de série

If you have more than one restaurant with an AC220-V2 dairy dispenser, please submit an additional form for each location. The link to the SureShot NextGen New Dairy Valve form will be provided again once you've selected the Submit button below.