* Indicates a required field.

* Name (first, last):
Company (if applicable):
* Type of Pond:	Single Homeowner Business Condominium Association Subdivsion
* Address:
* City:
* State:	-- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
* Zip:
* Phone:
Fax:
* E-mail:
Pond's Physical Address -
	Same as above.
Address:
City:
State:	-- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
Zip:
Pond Information -
* # of Ponds:
* Ages of Ponds:
* Sizes of Ponds:	1st Pond: Average Length Average Width 2nd Pond: Average Length Average Width 3rd Pond: Average Length Average Width
* Pond Shape:	Kidney Circle Oblong Triangle Other:
* Current Aeration System: (check all that apply)	Bubbler Fountain Windmill None
Pond Treatments -
* Has your pond been chemically treated before?	Yes No
If so, was it done professionally or by you?	Professionally Personally
* Weed problems that you struggle with in a normal summer: (check all that apply)	Algae Submerged Weeds Emergent Weeds Floating Weeds
* Can you identify the weeds?
* I need help with: (check all that apply)	Choosing an Aerator Troubleshooting Weed and Algae Problems Muck and Clarity Issues Finding a Dealer in my Area