Irrigation Form
*First Name:
*Last Name:
*Billing Address:
*Zip Code:
Mobile Number (for appointment reminders):
*Email (for appointment reminders):
Service Address (only fill out if different from Billing Address)
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:
  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.

Agreement and Authorization
By submitting this form, I authorize Gilford Well Company, Inc. to perform the following services:
Irrigation Service Description
Preferred Time of Year
Weather Permitting
Standard Rate
Prepaid Rate
Installation of pump (if required), suction hose, or backflow preventer. Check each zone for damaged parts (parts billed separately). Timer set for spring watering (may need to be adjusted when hot, dry weather arrives)
  Late April/May
  Late May/June
$150/hour or
One Hour Minimum
$140/hour if
Prepaid by April 15
One Hour Minimum
Pre-paying on line?
Use the word "prepay" in the invoice field
Blow out lines with air compressor. Remove pump/backflow (store at location or GWC). Note any repairs to be made in spring
  Late Sep/Oct
  Late Oct/Nov
(Pay when invoiced)
One Hour Minimum
No Prepaid Rate
For Winterization
  Please remove me from the list, I no longer require these 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.

© 2020 Gilford Well Company
Designed by The Chalifour Design Group, LLC