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Phone - (563) 359-3558
Fax - (563) 359-3881
POOL WINTERIZING
CUSTOMER NAME
ADDRESS
CITY STATE ZIP
HOME PHONE OTHER
E-MAIL YES NO
ABOVE GROUND ABOVE GROUND W/ MAIN DRAIN
INGROUND
SIZE OF POOL GALLONS
WILL THERE BE SOMEONE HOME? YES NO
IF NO ONE HOME (CUSTOMER COMMENTS)
IS THERE ACCESS TO AREA AND ELECTRICAL OUTLETS?
YES NO
TYPE OF PAYMENT
CASH CHECK CREDIT CARD DEBIT CARD
CREDIT OR DEBIT CARD # EXP
POOL MUST BE DRAINED 1” BELOW THE SKIMMER.
PLUGS AND EXPANSION BOTTLE OR GIZZMO SHOULD BE LEFT OUT BY SKIMMER.
DO YOU WANT US TO PUT A COVER ON?
YES NO HELP
WHAT TYPE OF COVER DO YOU HAVE?
WINTER SOLID COVER MESH SAFETY COVER
DO YOU WANT US TO ADD CHEMICALS? YES NO
WINTER KIT LIQUID CHLORINE