Gilford Well Company

Have questions? Give us a call (603) 556-7959

Irrigation Form

*First Name:

*Last Name:

*Billing Address:

*City:

*State:

*Zip Code:

Mobile Number (for appointment reminders):

*Email (for appointment reminders):

Service Address 1:

Service City 1:

Service Address 2:

Service City 2:
New Customers: Please provide service address(es) if different from billing.

Caretaker (skip this section if it does not apply to you):

First Name:

Last Name:

Mobile Number:

Email:

By checking this box, I authorize the above caretaker to schedule service appointments for my irrigation system. I understand that I will be billed directly for all repairs and services.

When will you be notified of your date of service?

Approximately one week in advance you will receive a call, email or text to schedule your appointment. If you find the appointment will not work for you, please contact us and we will do our best to accommodate your needs.

Appointment Reminders

An evening before reminder will be sent confirming your appointment and the anticipated time frame. On the day of the service you will receive a text alert when the technician is on the way to the service location. Please provide current contact information so you can take advantage of these notifications. Your information is confidential and will never be shared.

To prepay your irrigation simply select the "Pay Bill" button on the top ribbon of our website after you have submitted this form. The invoice number is a required field when making payment, type the word "PREPAY" as the invoice number.

We are committed to protecting your privacy at Gilford Well Company. We will not collect any personal information from you that you do not volunteer, and we are the sole owner of all information collected on this site. We do not sell, share, or rent this information to others in any way that we have not mentioned in this statement.