POOL SERVICE FORM
Your personal information will be kept confidential.
The information you submit is for our internal use only.

*Name:
*Address:
*City:
*State:
*Zip:
Home:		Best Contact #
Cell:		Best Contact #
Work:		Best Contact #
*Email:
*Type of Pool:		Inground Above ground
*Pool Size:
Manufacturer:
Model:
Age:
Was your pool purchased here?		Yes   No
* Please describe the type of service you require or problem you are having
*Do you have any pets in your yard?		Yes   No
*Do we have access to your pool?		Yes   No
Additional Comments or Requests
*Required
You have completed the POOL SERVICE FORM!
Pool & Patio Center will reply to your request within 48 hours. In the unlikely event you DO NOT hear from us within 48 hours we may be having technical problems with our network or our web site. If this is the case, please call us at (401) 823-7290.
POOL & PATIO CENTER, INC. 475 TIOGUE AVE., ROUTE 3 COVENTRY, RI 02816 PHONE (401) 823-7290 FAX (401) 828-3055 info@poolandpatiocenter.com © 2010 Pool & Patio Center, Inc. / All Rights Reserved / Privacy Statement