Job Submission Form

BRUCE R. ROACHE

PoolRepairDiver.com

Date*

Name of Person Submitting Request*

Name

E-mail of Submitting Person*

E-mail address

Phone of Submitting Person*

Area CodePhone Number

Pool Owners Name*

Pool Address*

Street Address

Street Address Line 2

CityState

Zip Code

Pool Type*

Leaking how many inches per day?*

How long has the pool been leaking?

RecentlyAll seasonLoss all winterNot leaking, other work requested

Water is Clear?*

YesNo

Bottom is Clean?*

YesNo

Pool is Full?*

YesNo

Your pool is:*

Open for Swim SeasonCovered and Winterized

Any VGB main drain safety covers needed?

PLEASE submit current photos of your pool. Photos are very helpful when we discuss your pool leak inspection. Select Image and Upload Image below:

Gate Codes, Locks, Keys?

Other Requests and Information

IMPORTANT POOL LEAK INSPECTION & REPAIR POLICIES:

Underwater Pool Inspections are not possible if the pool is filthy or I cannot see. The water must be safe and sanitary to swim in. Pool water must be filled to mid skimmer level, water clear so you can see the bottom of deepest area, bottom clean, no green algae and not covered with debris.

The best possible inspection & repair of all leaks is achieved when the pool is: FULL, WATER CLEAR, BOTTOM CLEAN and I have an accurate measurement of water loss per day.

If you send me to a pool that has cloudy water, a dirty or algae covered bottom, or is closed and covered; I will do the best I can, but there is NO GUARANTEE OF SUCCESS, and if more than one visit is needed, each visit will be billed.

Pipe testing is only possible if your pool piping has proper shutoff valves or disconnect unions that allow each pipe to be isolated and tested.

No swimmers are allowed in the pool during the Inspection, Testing and Underwater Repairs. Swimming can normally resume soon after service is completed. No one is allowed in pool area if pressure testing or ultrasonic ground listening is being done.

If any additional loss occurs after the Inspection & Repair, you must notify us within 7 days for a follow up re-inspection. Any report after 7 days will be treated as a new service call.

Invoices are due upon completion of work, payment is by check or cash only. Any invoice not paid within 30 days will incur a $5.00 per month Late Fee.

Summer Season	Memorial Day - Sep. 15
Off Season	Apr. 1 - Mem. Day + Sep. 16 - Oct. 31
Winter Season	Nov. 1 - Mar. 31

Job Request Form