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I WOULD LIKE TO SIGN-UP FOR SPLISH SPLASH POOL SERVICE. NEED HELP? 623-581-3111
 Chemical Service- $39.95/mo 
 Chemicals with filter backwash and baskets-$59.95/mo 
 Salt Water pool service-$39.95/mo (includes salt) 
 I have a prepaid voucher and would like to use it 
In-ground pools only. Splish Splash Pools
PREPAID VOUCHER NUMBER (if applicable)
EX: groupon, doozy of a deal, buy with me, etc..
I WOULD LIKE A FREE ESTIMATE ON
 New equipment 
 Repairs 
 Acid Wash 
 Cleaning Service 
 Green to Clean 
 Other 
MY FILTER TYPE IS
 Sand 
 D E  
 Cartridge 
 Unknown 
MY CURRENT POOL CONDITION IS *
 Clean and Clear 
 Green CAN'T see bottom 
 Greenish CAN see bottom 
 Needs to be drained 
 Cloudy 
 Other 


IS THIS A RENTAL HOUSE? *
 Yes 
 No 
**IF YES, YOU ARE?
 Owner 
 Renter 
NAME *

First

Last
Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Billing address (if different then Service)
Email *
Confirm Email *
HOME PHONE *

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CELL PHONE

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MAJOR CROSS ROADS OF POOL PROPERTY
HOW DID YOU HEAR ABOUT US? *
Friend, yahoo, google, groupon, doozy of a deal, truck, etc...
IF YOU ARE IN A GATED COMMUNITY PLEASE INDICATE GATE CODE
WHAT GATE IS BEST TO USE FOR POOL SERVICE WHEN FACING THE HOUSE?
 Right 
 Alley 
 Left 
 other 
IS YOUR GATE LOCKED?
 No 
 Yes-Please pick up key on first day of service 
 Yes-We will unlock on our service day 
 Please call for lock combination 
DO YOU HAVE DOGS? *
 Yes 
 No 
** IF YES, ARE YOUR DOGS
 Friendly (usually inside) 
 Friendly (usually outside) 
 NOT friendly need to be put in on service day 
MY POOL HAS
 A Pool sweep 
 Pop-ups 
 No auto cleaning system 
 other 
COMMENTS, QUESTIONS OR SPECIAL INSTRUCTIONS

IF YOU REMAIN ON THIS SCREEN AFTER SUBMITTING FORM, CHECK ENTRIES FOR ERRORS.

THANK YOU FOR YOUR TIME!
WE WILL BE CONTACTING YOU SHORTLY
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