Office 561-779-5544 – Brian 561-721-5617 – Greg 561-676-3735

Monthly Maintenance Agreement

Customer Name:

Service Address:

City, State, Zip:

Phone #:_

Email:

Gate Code:

Animals:

Frequency of Service:

Monthly

2xmonth

Quarterly(WHRO)

Annually(WHRO)

Monthly maintenance will be performed on a 4-week rotation (13 services per year) unless indicated otherwise. Service includes water testing, cleaning or changing sediment filter, timer reset if needed, chemicals added, salt added, pump checked, pressure tank checked. Customers will be notified if any problems are noticed. Equipment repairs or replacement are not included as part of the monthly maintenance service. This agreement may be cancelled at any time without penalty.

Prices: Maintenance Service - $60.00 + supplies*

Jupiter, Delray to Parkland $65.00 + supplies*

Second system on same property – additional $20.00 + supplies*

***Price for supplies subject to change without notice.

Billing and Payment (check one):

ACH

Credit Card #:

Exp:

CID::

Billing Name:

Email Address:

CUSTOMER MESSAGE: Payment made via Check can be mailed to Water Concierge Services at 583 105th Ave N, Suite 10, Royal Palm Beach, FL, 33411. A valid credit card or ACH information is required to be kept on file for automatic montly service billing. Any services, repair, or charges outside of the standard monthly service will be discussed with and approved by the client prior to billing.

Additional Information: