American Express Technologies Campus

Area of Interest

General
Water Conservation
Urinals

Name*

First Last

Email*

Phone

Comments

How did you hear of us?

Facility Details

Business Name*

Location

Type of Facility

Water Conservation

Approximate # of daily restroom users

# of Toilets and Brand(s)

# of Urinals and Brand(s)

# of Sinks and Faucets

# of Showers

# of Pre-Rinse Spray Valves

Urinal Specific Details

Do you have a regular daily custodial service for the urinals?

Day
Night
Both
Not cleaned daily

Is your custodial team:

In House
Contract

Approximate # of daily male restroom users

What is your focus for installing Ecoblue Cube System?

Check all that apply

Water Conservation
Green Initiative Program
Economic
Cleanliness
Odor Control

Please provide photographs of your urinals (see examples below)

1. Group photo of all urinals from a distance.
2. Photo of each different type of urinal bowl per restroom (we specifically require a picture of inside the bowl, so water level is clear visible. It is most important to remove any plastic screens or pucks which may be present.)
3. Photo of each different type of flushing mechanism on the urinals.

Drop files here or

Accepted file types: png, jpg, gif, Max. file size: 5 MB.