Serving Pasco County, New Tampa, and Surrounding areas | 1-833-519-POOL

Intake Form - Customer Present

Full Name *

Email *

Phone *

Address *

Country

How did you hear about us? *

Pool Structure/Surface & Equipment Check

Estimate Pool Size (gallons): _ *

Enclosure *

Pool Surface *

Condition *

System Type *

Filter Baseline Pressure (psi): *

Pool Deck Type: *

Pool Deck Type Condition *

Equipment/Pool Condition

Pump Brand: *

Model: *

Condition *

Filter Brand: *

Model *

Condition *

Salt Cell Brand *

Model 3: *

Condition *

Heater Brand *

Model 4: *

Condition *

Auto Vac Brand: *

Model 5: *

Condition *

Water Chemistry & Components

Free Chlorine *

(Min; 1.0) (Ideal; 2.0-4.0) (Max; 5.0)

pH *

(Min 7.2) (Ideal; 7.4-7.6)(Max;7.8)

Total Alkalinity *

(Min;60) (Ideal;100-120) (Max;180)

Calcium Hardness *

(Min;150) (Ideal;200-400) (Max;1,000)

Cyanuric Acid *

(Min;XX) (Ideal;30-50) (Max;XX)

Phosphate *

(Min;XX) (Ideal;0-125) (Max;500)

Salt *

(Min;2600) (Ideal;3200) (Max;3600)

Components

Jets *

Skimmer Box *

Skimmer Basket *

Algae Present *

Signs of Leak *

Calcium Build-Up *

Plumbing Labeled *

Critical Safety Items – These items must be corrected prior to any routine pool services can be completed.)

Main Drain:

Properly Secured *

Cracked/Damaged: *

Anti-Entrapment Compliant: *

Skimmer Lid:

Present: *

Damaged/Cracked *

Gates/Doors:

Appropriate Latches: *

Electrical:

Grounded: *

Exposed Wires: *

Appropriate Panel: *

Pool Light

Working: *

Cover *

Coping/Tiles:

Loose: *

Cracked *

Missing: *

Notes *

Required Start-Up Cost: *

Optional Start-Up Cost: *

Monthly Service Rate *

Intake Form (If Customer Is Present) Completed By ? *

Signature *

Clear

Tips For a poolfect pool

833-519-POOL (7665)

30610 Summer Sun Loop

Wesley Chapel, Florida 33545

"POOLfection USA LLC, your comprehensive pool cleaning and maintenance partner. Offering Swimming Pool Cleaning Services across Florida © POOLfection USA LLC 2023 FL Lic. # ABC12345 POOLfection USA LLC is fully compliant with the Florida Department of Licensing and Regulation.