Authorization Form

**Please note that if you have not already scheduled your closing date with us filling out this form will not guarentee you a date.

Please fill in your information below.
« = Required Field

Authorization:
I authorize Gallagher Pools and Spas to perform any minor repairs or service during my closing that they may find need to be performed.
I do not authorize Gallagher Pools and Spas to perform any minor repairs or services during my pool closing. I understand that by checking this any extras will require a return trip which will require and extra labor fee.
Note: If a return trip is needed to perform these repairs/services an extra labor fee will be charged.«
Explanation of Services:
I have read and understand the explanation of services listed on the winter services page.
I have NOT read or do not understand the explanation of services listed on the winter services page.
.«
Vacuuming:
I authorize Gallagher Pools and Spas to vacuum my pool for $85.00 per hour - only if necessary.
I do not authorize Gallagher Pools and Spas to vacuum my pool for $85.00 per hour. I understand that a pool closed with leaves and debris in it may result in poor water condtion and/or stains..«
First Name:

 Last Name:
 
Address:
City:

 State:

 Zipcode:
Email:

Phone:

Where should my equipment be stored?

Where is my cover?

  
Deposit:
I authorize Gallagher Pools and Spas to charge the card I am listing for the amount below
I will be bringing cash or a check to the store. I understand my date will not be held until I pay a $200 deposit.«

Credit Card Number

  

Expiration Date

  

Security Code (three digit number on back)

  

Amount I permit Gallaghers to charge ($200 minimum deposit required to hold the date)
$

  

  

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