First Name
*
Last Name
Billing Address
Address
Street Address
City
State
Country
Postal Code
Business Name
Job Title
Phone Number
*
Email
*
What industry are you in?
*
Food Processing
Seafood Processing
Poultry
Beverage / Bottling
Agriculture
Cannabis
Hospitality
Cruise Line / Maritime
Healthcare
Education / Schools
Dental
Cleaning Company / Janitorial
Manufacturing
Other
Which system are you planning to lease?
EcoloxTech 300
EcoloxTech 1200
E300 System Configuration
System Only – $625 deposit – $500/month
System + 15 Gal Tank – $675 deposit – $650/month
System + 60 Gal Tank + Pump – $900 deposit – $800/month
E1200 System Configuration
System Only – $3,500 deposit – $1,750/month
System + 60 Gal Tank + Pump – $3,900 deposit – $1,900/month
System + 120 Gal Tank + Pump – $4,200 deposit – $2,050/month
Installation Address
Street Address
City
State
Postal Code
