2010 Maintenance Request

Name First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Email
Pool Summerization Please have pool ready by(date):

We will begin Pool Summerizations approximately 3 weeks prior to "ready by" date.
Spa Summerization Please have spa ready by(date):

We will begin Spa Summerizations approximately 2 weeks prior to "ready by" date.
Maintenance Services Weekly Maintenance Pool Only Weekly Maintenance Spa Only Pool and Spa Maintenance
I hereby authorize Harbor Hot Tubs, Inc. to apply the charges described here to the following account (please initial here):
Type of Card (MC/Visa/Amex)
Card Number
Exp. Date
CVV2#
Billing Address on Card
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Comments