Weekly Maintenance Billing Setup Form

Weekly Maintenance Billing Information

Weekly Maintenance Contract Number:

(if available)

Weekly Maintenance Pre-Authorization of $1

Name*

First Last

Billing Address*

Street Address Address Line 2 City State ZIP Code

Best Phone Number To Reach You*

Email*

Pre-Authorization To Set Up Billing Account

$0.00

Credit Card*

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Credit Card Authorization:*

I Agree - By clicking 'Make Payment' I am authorizing Excel Pool Service authorize my credit card today for $1 to set up by billing profile, and to charge my credit/debit card on file for the weekly service amounts specified in my Weekly Maintenance Agreement.