2022 RI_SpringStartupForm

Customer Name*

Property Address Needing Service*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Subdivision

Is the service address the same as the billing address?*

YesNo

Billing Address/Info

Phone Number*

Area CodePhone Number

E-mail*

I would like to have my invoice e-mailed to me.

We mail all invoices by default unless you select the option above to receive them by e-mail instead. Please make sure to whitelist our email address to avoid missing the invoice due to spam filters.

We invoice AFTER work has been completed.

Do you need your annual Backflow Preventer Test Completed?*

YesI am not sure when my backflow test is due, can you check for me?No, I do not want my backflow tested.No, Reitzel Irrigation or someone else already tests my backflow at a different time in the year.N/A, my irrigation doesn't use city water, I have a well or pump out of the lake

Service #, Location ID or CCN from Letter

VERY IMPORTANT! Found on the notification letter from the city. For Kannapolis/Harrisburg/Union Co the CCN is required to do the test and for Concord the Location/Device ID Is required.

Would you like us to automatically fix any problems and add them to your invoice?*

Yes, fix any problems and I understand I will be billed for the materials and labor.No, I understand I will receive a description of repairs needed with my invoice

Does someone need to be home? If you have flexible scheduling or know what days you are going to be home, please note that in the comments section.*

YesNoYes, but my schedule is flexible. I will provide details in the Comments section.

If you are currently NOT ready to have your system turned on, please enter the date AFTER which you want it turned on.

Date

Comments

Please note any known problems you would like addressed above or any comments you have to add to this service request.

How did you hear about/find us?*

*

I agree that by submitting this service form that I will pay all applicable service/materials charges as invoiced and that any verbal authorizations/approvals of work are hereby binding. I also agree to pay per the terms listed on the final invoice and a 1.5% monthly interest (18% per annum, $5 per month minimum charge) charge on overdue balances and all collection costs incurred.

2023 Spring Startup Form