Weekly Chemical Pool Service Enrollment

Weekly Chemical Pool Service Enrollment Form

Customer Information Form
This Form Must be Completely Filled Out or Your Service Request Will Not be Processed

First Name:
Last Name:
Address:
City:
State:
Zip Code:
Email:
Phone:
Alt. Phone:
Service Address (if different from billing address above):

(100 remaining)

Cancellation Policy

In the unlikely event that you are unsatisfied with our Service, we will refund any unused portion of the received payment. All cancellations are to be presented in writing stating your reasons for dissatisfaction of Service. Please note that if you sign up for this Service only to get us to clear up your pool water in the Spring and then cancel this service, you will be charged a $250 cancellation fee.

Payment Method

Credit Card Prepayment
Please Select Amount to Charge:

Chlorine Pools
(Includes $100 Seasonal Discount) Due May 1st
$1300
First Payment Due May 1st
$700
Second (Final) Payment Due July 1st
$700
Salt System Pools
(Includes $100 Seasonal Discount) Due May 1st
$1250
First Payment Due May 1st
$700
Second (Final) Payment Due July 1st
$550

Please Fill in the Following Information:

Credit Card Number:
Credit Card Expiration Date:
3 or 4 Digit V Code:
   (security check, enter the letters you see to the left)

Please Note: By submitting this order you agree to the terms and conditions of the Weekly Chemical PoolService.

For payment made by check, use your browsers print function to print this form. Please mail completed form along with the appropriate payment to:

Pool Products Direct
263 Pineridge Lane
Stillwater, MN 55082-7102

This Form Must be Completely Filled Out or Your Service Request Will Not be Processed


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