5525 Manitou Lane SewerP. O. Box 41155
Plymouth, NIN 55441
W ORDER FORM
INV NOTE: THIS IS NOT AN
- 6 O ffice
(763) 263-7773 Fax
All Pavments are due upon completion of work unless a legal business entitv. Please make checks payable to, merican Lea Detection.
I acknowledge that I have read, understand and agree: 1) to the terms, DETECTION FEE S
conditions and guarantees as described on the back of this form 2) the above REPAIRS $
charges 3) the payment of reasonable charges for collection, including OTHER S�� f
attorney's fees and a 1.5% per month (I S% per year) late payment fee on any AMOUNT PAID $ �� (DO DATE PAID
unpaid balance remaining after 10 days from date of invoice. 4) I authorize CC NUMBER #
American Leak Detection to complete t above described work. EXP D E
SIGNET) BY: DATE: You will receive a final report /invoice in the mail.
M
JOB INFORMATION
DATE: TIME OF CALL: TAKEN BY: REPAIR OK'D: REFERRAL: cl-n- i
TECH: CALLED IN BY: DATE OF JOB: TIME:
CROSS STREETS: (S $ - —.� —T PO /CLAIM #:
DIRECTIONS: HOME:
JOB SITE
BILLING
NAME:
NAME: L ! %)
CONTACT:
CONTACT:
^� } /
ADDRESS: t '.:.�
/
c~; C `/ /
ADDRESS: 1 E f �Cl
�
CITY /STATE ZIP:
PHONE: WK PHONE:
CITY /STAT (t- i;�.�!1� ZIP6 ,S
PHONE: 5 WK PHONE:
JOB TYPE
❑ Pool ❑ Gunite '❑ Vinyl ❑ Fiberglass ❑ Above G
El Pool /Spa Combo Other
❑ Spa Waterloss l Hours
❑ Open ❑ Closed Pump ON ❑ More ❑ None
❑ Yes ❑ No Pool clean ❑ Covered
❑ Repair ❑ Pool ❑ Spa ❑ Patch
❑ Residential ❑ Commercial ❑ Municipal
❑ Drain Inspection ❑ Drai tle
wer Camera ocate
11 Failed Inspection ❑Slab
❑ Main Line ❑ Service Line
Sour e & Origin ❑ Other
GENERAL JOB INFORMATION
BD SK RT SW E�
J17 (-f - e�--
''�
t - � `'' - � 102
/ / u % �i
_
12/D In/ A A—)
TIME ON JOB
All Pavments are due upon completion of work unless a legal business entitv. Please make checks payable to, merican Lea Detection.
I acknowledge that I have read, understand and agree: 1) to the terms, DETECTION FEE S
conditions and guarantees as described on the back of this form 2) the above REPAIRS $
charges 3) the payment of reasonable charges for collection, including OTHER S�� f
attorney's fees and a 1.5% per month (I S% per year) late payment fee on any AMOUNT PAID $ �� (DO DATE PAID
unpaid balance remaining after 10 days from date of invoice. 4) I authorize CC NUMBER #
American Leak Detection to complete t above described work. EXP D E
SIGNET) BY: DATE: You will receive a final report /invoice in the mail.
M