To finalize registration please complete all fields of application, print, sign and mail or fax application and insurance documentation to Alliance Laundry Systems. Fax number and address are provided below.
Home Laundry
Authorized Service Application
Alliance Laundry Systems
Shepard Street, P.O. Box 990
Ripon, WI 54971
Fax: (920) 748-4498
Company Date
Address
City State Zip
County Phone
Contact Person Owner Manager
Fax # Email Address
FLAT SERVICE RATES
OR
INCREMENTAL SERVICE RATES
Service Call (Flat Rate) Type A - All machine repairs, except major part replacements.
Trip Charge Plus 30 - First 30 minutes in home.
Service Call (Flat Rate) Type B - All repair where major parts are replaced, such as transmissions, outer tubs, trunnion bearing, bases.
Each 15 minutes after first 30 minutes
Mileage Radius
Mileage Radius
Per mile charge beyond radius
Per mile charge beyond radius
PAYMENT METHOD
Check EFT Bank Routing # (required for EFT) ___________________________
And Account # ______________________________________
TAX INFORMATION (Choose One)
Sole Proprietorship - Individual
Social Security No.
 Partnership - Tax I.D. No.
 Corporation - No number needed
The parties in this agreement are independent contractors and nothing in this agreement will be taken to be an employee/employer or other business relationship other than an independent contractor relationship. Authorization for warranty service repairs are applicable only to products sold by Alliance Laundry Systems.
Factory agrees to pay Servicer agreed upon rates for service performed under the terms of the applicable warranty.
Pending approval of this application, I agree to perform service on Alliance Laundry Systems products according to the policies set forth by Alliance Laundry Systems.
Service Company Signature _________________________ Date _______________
Distributor Signature ______________________________ Date _______________
Alliance Laundry Systems approval ___________________ Date _______________
Service Company will also need to provide copies of documents showing:
  1. Proof of Liability Insurance
  2. Proof of Vehicle Insurance
  3. Worker’s Compensation Insurance (if applicable).
  4. List of Zip Codes where you service.
Alliance Laundry Systems Use ONLY:
Service company Account # ___________________ Service company Extranet Password:___________________

Note: To finalize registration please complete application, print, sign and mail or fax application and insurance documentation to Alliance Laundry Systems.

Form No. 4123R1-Web