Primary Contact Name*

First Last

Phone Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

On what floor level will the equipment be installed?*

What room will the equipment be installed in?*

Within how many feet can the truck and trailer come to the delivery entrance?*

Total number of stairs into the installation location? (Interior & Exterior)*

How many turns or corners are on the stairs?

What is the width of the narrowest set of stairs?

How many doorways must the equipment pass through to complete the installation?*

What is the width of the narrowest door the equipment must pass through? Please account for trim, door handles, and the door itself.*

How many hallways must the equipment pass through to be installed? (Please note the number, and the width of the narrowest portion below)*

What is the width of the narrowest portion of hallway?*

How many turns or corners are in the hallways the equipment will be required to pass through? (Please note the width of the narrowest corner below)*

What is the width of the narrowest corner?*

What type of flooring is in the facility?*

Will we be removing an existing piece of equipment?*

Yes
No

If yes, please describe the piece of equipment.

Will Better Body Fitness be disposing of this equipment, or moving it to another area of the house?

Please enter any additional information that may be helpful to the Service Technicians as they are installing your equipment. (Steep driveways, difficult landscaping, etc.)

Please Note the Following:

Installation can take one or more hours to complete depending on the amount of equipment being installed, and the challenges the installation location presents to our Service Technicians. Additional charges may apply if any obsticles increase the risk and difficulty of the installation, and require additional Service Technicians. A 24-Hour Cancellation Notice is required, and charges may apply as a result of failure to cancel or reschedule your installation appointment a minimum of 24 hours before your scheduled appointment.

Better Body Fitness of Montana, Inc. reserves the right to decline installation of product(s) due to dangerous or high risk factors not disclosed in this Home Site Survey.

By signing below you are agreeing to the terms set forth by and agree to any applicable fees as described above.*

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Date*

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Residential Site Survey

Please Note the Following: