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Company Name: 
First Name:   
Last Name:   
Street Address:   
City:   
State:   
Zip Code:   
Phone:   
E-Mail:   
Model:   
S/N:   
Date of Purchase:   
Warranty:  Yes No
Installation Date:   
  
Installation Description: (Pond waterfall, pond-less waterfall, fountain)


Waterfall Height ft.

Discharge Hose Diameter and Length: in.  ft.

Additional Plumbing Fixtures: (elbows, valves, in-line filters)

  
Failure Date & Description:  

  
Continuous Duty:    Yes  No
  
Duty Description:
  
Installed with Waterfall/Biological Filtration Pond Kit:
Yes  No
  
Filter Brand: (Easy Pro, Savio, PondEco, PondSweep, Aquascape)
  
Filter Model:    
  
Type of biological filter media used: (Pads, Brushes, Ribbon, Plastic Forms, Sponge)
  
Filter Condition:
  
Filter Cleanse or Change Frequency:
  
Date of last filter cleanse or change:

 



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