Laundry installation application

Information for resellers

Company name:

Contact person:

(Mobile) phone number:

Information about the location of the installation

Customer name:

Address:

Department:

Contact person and (mobile) phone number:

Make and type of washing machine:

Volume of washing machine:

Space behind the machine?:
—Kies een optie—YesNo
Photos of the back, front and where the pump should be placed:

How many products and which ones?:

Which dosing system?:


Signed by:


Signature: