DISTILLED WATER CUSTOMER SIGN UP

To sign up for our distilled water services please fill out the form below or download the form here and fax or mail it to the following address:

The Water Distillery, LLC

P.O. Box 110

Maple Valley, WA 98038

Rental Agreement / Account Policies

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Water Dispenser Monthly Lease	$ __________________________________ Deposit $ _________________________________

Number of Bottles:

Size:

Program:

Please Note: Bottle Caps are re-usable. There is a charge of $0.50 per cap to replace.

Initial Here:

Place of Employment:

Telephone:

I agree that all charges for rental, damage, cleaning or material will be paid and all collection fees, attorney fees, court costs, or any other expenses involved in the collection of these charges will be borne by me in the court of the county in wich the indebtedness is incurred. Payments past 90 days are subject to an 18% charge of amount owed. I further agree that if the amount is referred for collection, to pay collection fees not the exceed 35% of the commercial claim and reasonable attorney fees. The venue of any collection action based on this agreement shall lie in King County, Washington. I have fully read and understand the above terms.

Customer Name:

Customer Address:

Customer City:

Customer Zip:

Customer Email:

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