Irrigation System Maintenance Agreement

 

Service Address:

 
Service City:

New Customers: Please provide service address
if different from billing.

Billing Information:
* Required

 
 

*First Name:

 

*Last Name:

 

*Billing Address:

 

*City:

 

*State:

 

*Zip Code:

 

*Mobile Number (for appointment reminders):

 

*Email (for appointment reminders):

 

 
Caretaker (skip this section if it does not apply to you):

 
*First Name:                                               Mobile Number:
       

 
*Last Name:                                               Email:
       

 

By checking this box, I authorize the above caretaker to schedule service appointments for my irrigation system. I understand that I will be billed directly for all repairs and services.

 

Agreement and Authorization

 
This agreement will remain in effect until terminated by either party in writing. In the event of a price increase, you will be provided with a new agreement prior to spring start-up season.

 
By submitting this form, I authorize Gilford Well Company, Inc. to perform the following services (select the services you want each year):

 

Service Description

Preferred Time of Year

Standard Rate

Prepaid Rate

Start-Up

  • Installation of pump (if required), suction hose, or backflow preventer
  • Check of each zone for damaged parts (parts are billed separately)
  • Timer set for spring watering (may need to be adjusted when hot, dry weather arrives)

Early Spring
Mid Spring
Late Spring

$120/hour

$110/hour
(if paid by April 15)

Winterization

  • Blow out lines with air compressor
  • Remove pump/backflow (store at location or GWC)
  • Note any repairs to be made in spring

Early Fall
Mid Fall
Late Fall

$110/hour
(billed when complete)

Does not apply

Please remove me from the list, I no longer require these services

 

 

Credit Card (Optional Pre-Payment):

 

 

Credit Card Number:

 

Expiration Date:

 

Amount to Charge:

 

CVC#:

what is this?The Credit Card Verification Value is the 3 digit code on the back of your card.

 

I Authorize Gilford Well Company to charge
the above credit card for the amount given:
    YES

 


Please type this verification code below:

 

         

 

 
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